TY - JOUR AU - Yeung, Kan Andy Wai AU - Hammerle, Peter Fabian AU - Behrens, Sybille AU - Matin, Maima AU - Mickael, Michel-Edwar AU - Litvinova, Olena AU - Parvanov, D. Emil AU - Kletecka-Pulker, Maria AU - Atanasov, G. Atanas PY - 2025/4/8 TI - Online Information About Side Effects and Safety Concerns of Semaglutide: Mixed Methods Study of YouTube Videos JO - JMIR Infodemiology SP - e59767 VL - 5 KW - YouTube KW - semaglutide KW - social media KW - Ozempic KW - Wegovy KW - Rybelsus KW - safety KW - knowledge exchange KW - side effects KW - online information KW - online KW - videos KW - health issues KW - drugs KW - weight loss KW - assessment KW - long-term data KW - consultation N2 - Background: Social media has been extensively used by the public to seek information and share views on health issues. Recently, the proper and off-label use of semaglutide drugs for weight loss has attracted huge media attention and led to temporary supply shortages. Objective: The aim of this study was to perform a content analysis on English YouTube (Google) videos related to semaglutide. Methods: YouTube was searched with the words semaglutide, Ozempic, Wegovy, and Rybelsus. The first 30 full-length videos (videos without a time limit) and 30 shorts (videos that are no longer than 1 minute) resulting from each search word were recorded. After discounting duplicates resulting from multiple searches, a total of 96 full-length videos and 93 shorts were analyzed. Video content was evaluated by 3 tools, that is, a custom checklist, a Global Quality Score (GQS), and Modified DISCERN. Readability and sentiment of the transcripts were also assessed. Results: There was no significant difference in the mean number of views between full-length videos and shorts (mean 288,563.1, SD 513,598.3 vs mean 188,465.2, SD 780,376.2, P=.30). The former had better content quality in terms of GQS, Modified DISCERN, and the number of mentioned points from the custom checklist (all P<.001). The transcript readability of both types of videos was at a fairly easy level and mainly had a neutral tone. Full-length videos from health sources had a higher content quality in terms of GQS and Modified DISCERN (both P<.001) than their counterparts. Conclusions: The analyzed videos lacked coverage of several important aspects, including the lack of long-term data, the persistence of side effects due to the long half-life of semaglutide, and the risk of counterfeit drugs. It is crucial for the public to be aware that videos cannot replace consultations with physicians. UR - https://infodemiology.jmir.org/2025/1/e59767 UR - http://dx.doi.org/10.2196/59767 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59767 ER - TY - JOUR AU - Keel, K. Pamela AU - Bodell, P. Lindsay AU - Ali, I. Sarrah AU - Starkey, Austin AU - Trotta, Jenna AU - Luxama, Woody J. AU - Halfhide, Chloé AU - Hill, G. Naomi AU - Appelbaum, Jonathan AU - Williams, L. Diana PY - 2025/4/8 TI - Examining Weight Suppression, Leptin Levels, Glucagon-Like Peptide 1 Response, and Reward-Related Constructs in Severity and Maintenance of Bulimic Syndromes: Protocol and Sample Characteristics for a Cross-Sectional and Longitudinal Study JO - JMIR Res Protoc SP - e66554 VL - 14 KW - binge eating KW - weight suppression KW - leptin KW - glucagon-like peptide 1 KW - insulin KW - reward KW - satiation KW - longitudinal KW - behavior KW - Research Domain Criteria N2 - Background: Bulimia nervosa and related syndromes (BN-S) characterized by binge eating vary considerably in illness severity and course. Using the Research Domain Criteria framework of the National Institute of Mental Health, we developed a model positing that the same set of physiological consequences of weight suppression (WS; defined as the difference between the highest and current adult body weight) contribute to binge-eating severity and maintenance by (1) increasing the drive or motivation to consume food (reward valuation effort [RVE]) and (2) decreasing the ability for food consumption to lead to a state of satiation or satisfaction (reward satiation). Objective: Our funded project aimed to test concurrent associations among WS, physiological factors (leptin concentrations and postprandial glucagon-like peptide 1 [GLP-1] response), behavioral indicators of RVE (breakpoint on progressive ratio tasks) and reward satiation (ad-lib test meal intake), self-report of these core constructs, and binge-eating severity in BN-S (aim 1); test prospective associations to determine whether WS predicts BN-S maintenance in longitudinal models and whether posited mediators also predict BN-S maintenance (aim 2); and determine whether associations between WS and BN-S severity and maintenance are mediated by alterations in leptin levels, GLP-1 response, RVE, and reward satiation (aim 3). Methods: We aimed to recruit a sample of 320 women with BN-S or noneating disorder controls, with BMI from 16 kg/m2 to 35 kg/m2, for our study. The study included diagnostic interviews; questionnaires; height, weight, and percentage of body fat measurements; weight history; fasting leptin level; postprandial GLP-1 and insulin responses to a fixed meal; and ad-lib meal and progressive ratio tasks to behaviorally measure reward satiation and RVE, respectively, at baseline, with at least 78.1% (250/320) of the participants providing data at 6- and 12-month follow-up visits. Data will be analyzed using structural equation models to test posited pathways. Results: Data collection began in November 2016 and ended in April 2023, pausing in-person data collection from March 2020 to February 2021 due to the COVID-19 pandemic. Of 399 eligible women enrolled, 290 (72.7%) provided clinical, behavioral, and biological data at baseline, and 249 (62.4%) provided follow-up data. Measures demonstrated strong psychometric properties. Conclusions: We seek to identify biobehavioral predictors to inform treatments that target key factors influencing the severity and course of binge eating. These data, supported solely through federal funding, can inform questions emerging from recent interest and controversy surrounding the use of GLP-1 agonists for binge eating. International Registered Report Identifier (IRRID): RR1-10.2196/66554 UR - https://www.researchprotocols.org/2025/1/e66554 UR - http://dx.doi.org/10.2196/66554 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66554 ER - TY - JOUR AU - Johnson, Hans AU - Huang, David AU - Liu, Vivian AU - Ammouri, Al Mahmoud AU - Jacobs, Christopher AU - El-Osta, Austen PY - 2025/3/31 TI - Impact of Digital Engagement on Weight Loss Outcomes in Obesity Management Among Individuals Using GLP-1 and Dual GLP-1/GIP Receptor Agonist Therapy: Retrospective Cohort Service Evaluation Study JO - J Med Internet Res SP - e69466 VL - 27 KW - obesity KW - weight loss KW - semaglutide KW - tirzepatide KW - digital health KW - engagement KW - behavior KW - coaching KW - retrospective study KW - service evaluation N2 - Background: Obesity is a global public health challenge. Pharmacological interventions, such as glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (eg, tirzepatide), have led to significant weight loss among users. Digital health platforms offering behavioral support may enhance the effectiveness of these medications. Objective: This retrospective service evaluation investigated the impact of engagement with an app-based digital weight loss program on weight loss outcomes among individuals using GLP-1 receptor agonists (semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (tirzepatide) in the United Kingdom over 5 months. Methods: Data were collected from the Voy weight loss digital health platform between February 2023 and August 2024. Participants were adults aged 18-75 years with a BMI ?30 or ?27.5 kg/m2 with the presence of obesity-related comorbidities who initiated a weight management program involving semaglutide or tirzepatide. Engagement was defined based on attendance at coaching sessions, frequency of app use, and regular weight tracking. Participants were categorized as ?engaged? or ?nonengaged? accordingly. Weight loss outcomes were assessed over a period of up to 5 months. Statistical analyses included chi-square tests, independent t tests, Kaplan-Meier survival analysis, and calculations of Cohen d for effect sizes. Results: A total of 57,975 participants were included in the analysis, with 31,407 (54.2%) classified as engaged and 26,568 (45.8%) as nonengaged. Engaged participants achieved significantly greater weight loss at each time point. At month 3, engaged participants had a mean weight loss of 9% (95% CI 9% to 9.1%) compared with 5.9% (95% CI 5.9% to 6%) in nonengaged participants (P<.001), representing a mean difference of 3.1 percentage points (95% CI 3.1% to 3.1%). A Cohen d effect size of 0.89 indicated a large effect. At month 5, engaged participants had a mean weight loss of 11.53% (95% CI 11.5% to 11.6%) compared with 8% (95% CI 7.9% to 8%) in the nonengaged participants (P<.001). A Cohen d effect size of 0.56 indicated a moderate effect. Participants using tirzepatide achieved more significant weight loss than those using semaglutide at month 5 (13.9%, 95% CI 13.5% to 14.3% vs 9.5%, 95% CI 9.2% to 9.7%; P<.001). The proportion of engaged participants achieving ?5%, ?10%, and ?15% weight loss was significantly higher than the nonengaged group at corresponding time points from months 3 to 5 respectively (P<.001). Conclusions: Engagement with a digital weight management platform significantly enhances weight loss outcomes among individuals using GLP-1 receptor agonists. The combination of pharmacotherapy and digital behavioral support offers a promising strategy to promote the supported self-care journey of individuals seeking clinically effective obesity management interventions. UR - https://www.jmir.org/2025/1/e69466 UR - http://dx.doi.org/10.2196/69466 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69466 ER - TY - JOUR AU - Hagiwara, Yuta AU - Adachi, Takuji AU - Kanai, Masashi AU - Shimizu, Kotoe AU - Ishida, Shinpei AU - Miki, Takahiro PY - 2025/3/27 TI - Interactive Effects of Weight Recording Frequency and the Volume of Chat Communication With Health Care Professionals on Weight Loss in mHealth Interventions for Noncommunicable Diseases: Retrospective Observational Study JO - Interact J Med Res SP - e65863 VL - 14 KW - weight change KW - behavior modification KW - health care communication KW - weight recording KW - chat communication KW - text communication KW - health care professionals KW - weight loss KW - mHealth KW - mobile health KW - app KW - digital health KW - smartphone KW - mobile health intervention KW - noncommunicable disease KW - NCD KW - weight loss outcome KW - obesity KW - overweight KW - retrospective study KW - observational study KW - cerebrovascular disease KW - cardiovascular disease KW - lifestyle modification KW - mobile phone N2 - Background: Mobile health (mHealth) apps are increasingly used for health promotion, particularly for managing noncommunicable diseases (NCDs) through behavior modification. Understanding the factors associated with successful weight loss in such interventions can improve program effectiveness. Objective: This study examined factors influencing weight change and the relationship between weight recording frequency and chat volume with health care professionals on weight loss in individuals with obesity and NCDs. Methods: The participants had obesity (BMI ?25 kg/m²) and were diagnosed with NCDs (eg, hypertension, diabetes, dyslipidemia). The program included 12 telephone consultations with health care professionals. Only participants who completed the full 6-month program, including all 12 telephone consultations, and provided an end-of-study weight were included in the analysis. The primary outcome was the rate of weight change, defined as the percentage change in weight from the initial period (first 14 days) to the final period (2 weeks before the last consultation), relative to the initial weight. The key independent variables were proportion of days with weight recording and chat communication volume (total messages exchanged). An interaction term between these variables was included to assess moderation effects in the regression analysis. The volume of communication was measured as the total number of messages exchanged, with each message, regardless of who sent it, being counted as 1 interaction. Health care staffs were instructed to send a single scheduled chat message per week following each biweekly phone consultation. These scheduled messages primarily included personalized feedback, reminders, and motivational support. In addition, providers responded to participant-initiated messages at any time during the program. Furthermore, 1 professional responded to each participant. Hierarchical multiple regression and simple slope analyses were conducted to identify relationships and interactions among these variables. Results: The final analysis of this study included 2423 participants. Significant negative associations were found between the rate of weight change and baseline BMI (?=?.10; P<.001), proportion of days with weight recording (?=?.017; P<.001), and communication volume (?=?.193; P<.001). The interaction between proportion of days with weight recording and chat frequency also showed a significantly negative effect on weight change (?=?.01; P<.001). Simple slope analysis showed that when the proportion of days with weight recording was +1 SD above the mean, frequent chats were associated with greater weight reduction (slope=?0.60; P<.001), whereas no significant effect was observed at ?1 SD (slope=?0.01; P=.94) Conclusions: The findings suggest that both the proportion of days with weight recording and communication volume independently and interactively influence weight change in individuals with obesity and NCDs. UR - https://www.i-jmr.org/2025/1/e65863 UR - http://dx.doi.org/10.2196/65863 ID - info:doi/10.2196/65863 ER - TY - JOUR AU - Zakaria, Hala AU - Jabri, Hadoun AU - Alshehhi, Sheikha AU - Caccelli, Milena AU - Debs, Joelle AU - Said, Yousef AU - Kattan, Joudy AU - Almarzooqi, Noah AU - Hashemi, Ali AU - Almarzooqi, Ihsan PY - 2025/3/27 TI - Glucagon-Like Peptide-1 Receptor Agonists Combined With Personalized Digital Health Care for the Treatment of Metabolic Syndrome in Adults With Obesity: Retrospective Observational Study JO - Interact J Med Res SP - e63079 VL - 14 KW - metabolic syndrome KW - obesity KW - GLP-1 medications KW - hybrid model of care KW - digital health KW - effectiveness KW - digital engagement KW - hybrid care KW - adult KW - cardiovascular disease KW - type 2 diabetes KW - insulin resistance KW - efficacy KW - behavioral change KW - obese KW - zone health KW - weight loss KW - monitoring KW - tirzepatide KW - semaglutide KW - treatment KW - medication KW - telehealth KW - health informatics KW - glucagon-like peptide-1 N2 - Background: Metabolic syndrome (MetS) represents a complex and multifaceted health condition characterized by a clustering of interconnected metabolic abnormalities, including central obesity, insulin resistance, dyslipidemia, and hypertension. Effective management of MetS is crucial for reducing the risk of cardiovascular diseases and type 2 diabetes. Objective: This study aimed to assess the effectiveness of combining glucagon-like peptide-1 (GLP-1) and dual gastric inhibitory polypeptide (GIP)/GLP-1 agonists with a continuous, digitally delivered behavioral change model by an integrated care team, in treating MetS among individuals with obesity. Methods: The 6-month Zone.Health (meta[bolic]) weight loss program involved 51 participants (mean age 45, SD 10 years; mean BMI 35, SD 5 kg/m²), categorized by gender, and treated with either tirzepatide or semaglutide. Participants received continuous support via a digital health platform, which facilitated real time monitoring and personalized feedback from an integrated care team. Engagement levels with the digital platform, measured by the frequency of inbound interactions, were tracked and analyzed in relation to health outcomes. Results: Tirzepatide reduced waist circumference (WC) by ?18.08 cm, compared with ?13.04 cm with semaglutide (P<.001). Triglycerides decreased significantly with both drugs, with tirzepatide showing a reduction of ?64.42 mg/dL and semaglutide ?70.70 mg/dL (P<.001). Tirzepatide generally showed more pronounced improvements in fasting glucose, blood pressure (BP), low-density lipoprotein, and total cholesterol compared with semaglutide. Higher engagement with the digital health platform showed significant difference among the 3 groups; the group with the highest level of app-based interactions (?25 interactions) had the greatest WC reduction (mean ?19.04, SD 7.40 cm) compared with those with ?15 interactions (mean ?9.60, SD 5.10 cm; P=.002). Similarly, triglycerides showed the greatest reduction in the group with ?25 interactions (mean ?108.56, SD 77.06 mg/dL) compared with those with ?15 interactions (mean ?44.49, SD 50.85 mg/dL; P=.02). This group also exhibited the largest reduction in diastolic BP (mean ?10.33, SD 7.40 mm Hg) compared with those with ?15 interactions (mean ?0.83, SD 7.83 mm Hg; P=.004), and the most substantial decrease in fasting glucose levels (mean ?18.60, SD 10.82 mg/dL) compared with those with ?15 interactions (mean ?2.49, SD 27.54 mg/dL; P=.02). Participants in the highest quartile of digital engagement had a 60% greater likelihood of MetS reversal compared with those in the lowest quartile. Conclusions: This study shows that combining GLP-1 and dual GIP/GLP-1 agonists with a digital behavioral change model significantly improves MetS markers in individuals with obesity. Tirzepatide proved more effective than semaglutide, leading to greater reductions in WC and triglyceride levels, along with better improvements in fasting glucose, BP, and lipid profiles. Higher app-based engagement was linked to better health outcomes, with participants in the highest engagement group having a 60% greater likelihood of treating MetS compared with those with the lowest engagement. UR - https://www.i-jmr.org/2025/1/e63079 UR - http://dx.doi.org/10.2196/63079 ID - info:doi/10.2196/63079 ER - TY - JOUR AU - Wang, Xiao AU - Xiao, Yuxue AU - Nam, Sujin AU - Zhong, Ting AU - Tang, Dongyan AU - Li, Cheung William Ho AU - Song, Peige AU - Xia, Wei PY - 2025/3/27 TI - Use of Mukbang in Health Promotion: Scoping Review JO - J Med Internet Res SP - e56147 VL - 27 KW - mukbang KW - health promotion KW - eating behaviors KW - appetite KW - scoping review N2 - Background: Mukbang is a recent internet phenomenon in which anchors publicly record and show their eating through short video platforms. Researchers reported a tangible impact of mukbang on the psychological and physical health, appetite, and eating behavior of the public, it is critical to obtain clear and comprehensive insights concerning the use of mukbang to promote the viewers? appetite, eating behaviors, and health to identify directions for future work. Objective: This scoping review aims to comprehensively outline the current evidence regarding the impact of mukbang consumption on dietary behaviors, appetite regulation, flavor perception, and physical and psychological well-being. Specifically, we conducted an analysis of public perceptions and attitudes toward mukbang while summarizing the reciprocal influence it has on health promotion. Methods: This study was conducted as a scoping review following the Joanna Briggs Institute guideline and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We comprehensively searched 8 electronic databases in Chinese, English, and Korean languages. We also searched gray literature sources like Google Scholar and ProQuest. We used a data extraction chart to extract information relevant to the impact of mukbang on health. The extracted data were qualitatively analyzed to form different themes related to health, categorizing and integrating the results based on the type of study (qualitative, observational, and experimental). Results: This scoping review finally included 53 studies; the annual distribution exhibited a consistent upward trend across all categories since their initial publication in 2017. Based on the results of the analysis, we have summarized 4 themes, which showed that mukbang may have positive effects on viewers? appetite, food choices, and weight control; it can also meet the psychological needs of viewers and provide digital companionship and happiness. However, excessive viewing may also be harmful to viewer?s health, which has also caused health concerns for some viewers. Conclusions: This study conducted a comprehensive search, screening, and synthesis of existing studies focusing on mukbang and health across various languages and varying levels of quality, which has presented the analytical evidence of the relationship between mukbang and dietary behaviors, appetite, flavor perception, and health. According to the results, future research could consider analyzing the beneficial and harmful factors of mukbang, thereby further optimizing the existing mukbang videos accordingly to explore the potential of using mukbang for health intervention or promotion, so as to improve or customize the content of mukbang based on this scoping review, maximize the appetite and health promotion effects of mukbang videos. Trial Registration: INPLASY INPLASY2022120109; https://inplasy.com/inplasy-2022-12-0109/ UR - https://www.jmir.org/2025/1/e56147 UR - http://dx.doi.org/10.2196/56147 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56147 ER - TY - JOUR AU - Usui, Rui AU - Aomori, Maki AU - Kanamori, Shogo AU - Watabe, Setsuko AU - Sehi, Jamal Bi Tra AU - Kawano, Kei AU - Kanoya, Yuka PY - 2025/3/18 TI - Evaluation of a Smartphone-Based Weight Loss Intervention with Telephone Support for Merchant Women With Obesity in Côte d'Ivoire: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e69264 VL - 14 KW - West Africa KW - sub-Saharan Africa KW - obesity KW - noncommunicable diseases KW - mHealth KW - mobile health KW - eHealth KW - randomized controlled trial KW - Côte d'Ivoire KW - weight loss program N2 - Background: The obesity rate among women in Côte d'Ivoire is rising, particularly in urban areas. Merchantry is the leading occupation for women in the country, and merchant women face a high risk of obesity owing to their sedentary lifestyle. A previous survey indicated that the obesity rate among merchant women was 30%, double the national average. Furthermore, 82.2% of merchant women with obesity were unaware of their condition, and 40.1% expressed no interest in losing weight. While most weight loss programs target individuals ready to lose weight, community interventions should also address those with minimal readiness. Additionally, low-cost weight-loss interventions that do not require health professionals are needed in countries with limited medical resources. Smartphones could offer a cost-effective solution as they enable self-monitoring and remote communication. Objective: This study will evaluate a low-cost smartphone-based intervention that targets individuals who are not ready to lose weight without the involvement of health professionals. Methods: The intervention will run for 6 months, and its efficacy will be assessed in an unblinded, parallel-group, randomized controlled trial with 108 participants per group. All direct interventions for participants in this study will be carried out by staff without medical qualifications. The intervention group will receive weighing scales and be encouraged to record their weight with a smartphone app. Health education will be provided via weekly group messages and monthly phone calls. The evaluation will be conducted face-to-face. The primary outcome will be the weight change, and the secondary outcome will be differences in body fat percentage, abdominal circumference, and stage of behavioral change in weight loss behaviors from baseline to 3, 6, and 12 months. Results: In accordance with this protocol, the recruitment of participants started on August 26, 2024. A total of 216 participants were allocated, with 108 in the intervention group and 108 in the control group. The baseline survey began on November 15, 2024, and is currently ongoing as of the end of November 2024. Conclusions: This study will be the first in sub-Saharan African countries to implement a smartphone app-based weight loss program in sub-Saharan Africa that does not require direct intervention by health care professionals but specifically targets communities. Furthermore, if the effectiveness of this program is confirmed, it has the potential to serve as a low-cost sustainable weight loss model at the policy level. International Registered Report Identifier (IRRID): DERR1-10.2196/69264 UR - https://www.researchprotocols.org/2025/1/e69264 UR - http://dx.doi.org/10.2196/69264 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69264 ER - TY - JOUR AU - Kariuki, Jacob AU - Burke, Lora AU - Erickson, Kirk AU - Sereika, Susan AU - Paul, Sudeshna AU - Cheng, Jessica AU - Biza, Heran AU - Abdirahman, Amjad AU - Wilbraham, Katherine AU - Milton, Heather AU - Brown, Cornelius AU - Sells, Matthew AU - Osei Baah, Foster AU - Wells, Jessica AU - Chandler, Rasheeta AU - Barone Gibbs, Bethany PY - 2025/3/18 TI - Acceptability and Preliminary Efficacy of a Novel Web-Based Physical Activity for the Heart (PATH) Intervention Designed to Promote Physical Activity in Adults With Obesity: Protocol for a Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e67972 VL - 14 KW - obesity KW - physical activity KW - cardiometabolic risk, body positivity, cardiovascular fitness, self-efficacy N2 - Background: Even in the absence of weight loss, any level of physical activity (PA) can reduce the risk of cardiovascular disease among individuals with obesity. However, these individuals face multifaceted barriers that reduce their motivation and engagement in PA. They prefer programs that are convenient, fun to engage in, and feature people who they can relate to. Yet, there is a paucity of PA interventions that are designed to incorporate these preferences. We designed the web-based PA for The Heart (PATH) intervention to address this gap. Objective: This study aimed to describe the protocol of a study that aims to examine the acceptability and preliminary efficacy of PATH intervention among insufficiently active adults with obesity aged at least 18 years. Methods: This is a 6-month pilot randomized controlled trial (RCT), using a parallel design with 1:1 allocation to intervention or control group. The PATH intervention group is given access to the PATH platform, but the resources each participant can access are tailored according to their baseline fitness level. Control group receives a self-help PA handout. Both groups self-monitor their PA using Fitbit (Google) and have Zoom (Zoom Video Communications) meetings twice a month with either the health coach (intervention) or study coordinator (control). The outcomes at 6-months include acceptability, changes in PA, and cardiometabolic risk from baseline to 6-months. Results: We screened 763 individuals for eligibility and 89 participants were enrolled and randomized to the intervention (45/504, 50.6%) and control arms (44/504, 49.4%). The average age was 48.7 (SD 12.17) years, and most participants were female (81/504, 90.1%), Black (45/504, 50.6%), and non-Hispanic (83/504, 93.3%). No systematic differences in baseline characteristics were observed between the study arms. The 6-month intervention is currently underway, and the completion of follow-up data collection is expected in February 2025, with results to be published soon after. Conclusions: The PATH intervention offers a promising, evidence-based approach to overcoming the barriers that have hindered previous PA programs for adults with obesity. It can support new and existing programs to foster long-term maintenance of health-enhancing PA. Trial Registration: ClinicalTrials.gov NCT05803304; https://clinicaltrials.gov/study/NCT05803304 International Registered Report Identifier (IRRID): DERR1-10.2196/67972 UR - https://www.researchprotocols.org/2025/1/e67972 UR - http://dx.doi.org/10.2196/67972 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67972 ER - TY - JOUR AU - Downs, Symons Danielle AU - Pauley, M. Abigail AU - Rivera, E. Daniel AU - Savage, S. Jennifer AU - Moore, M. Amy AU - Shao, Danying AU - Chow, Sy-Miin AU - Lagoa, Constantino AU - Pauli, M. Jaimey AU - Khan, Owais AU - Kunselman, Allen PY - 2025/3/13 TI - Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e66637 VL - 14 KW - pregnancy KW - gestational weight gain KW - physical activity KW - healthy eating KW - overweight KW - obesity KW - intervention N2 - Background: Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a ?gold standard? intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform. Objective: The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability. Methods: This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ?30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models. Results: Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028. Conclusions: Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women. International Registered Report Identifier (IRRID): DERR1-10.2196/66637 UR - https://www.researchprotocols.org/2025/1/e66637 UR - http://dx.doi.org/10.2196/66637 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66637 ER - TY - JOUR AU - Männistö, A. Siniriikka AU - Pietiläinen, H. Kirsi AU - Muotka, Joona AU - Suojanen, Laura-Unnukka AU - Lappalainen, Raimo AU - Korpela, Riitta PY - 2025/3/12 TI - Coach-Assisted eHealth With Group or Individual Support for Employees With Obesity: Randomized Controlled Trial on Weight, Body Composition, and Health Metrics JO - J Med Internet Res SP - e60436 VL - 27 KW - eHealth KW - weight loss KW - acceptance and commitment therapy KW - weight-neutral KW - Healthy Weight Coaching KW - occupational health KW - digital health KW - body composition KW - obesity KW - psychobehavioral KW - intervention KW - health care KW - metabolic health KW - physiological change N2 - Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ?5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586 UR - https://www.jmir.org/2025/1/e60436 UR - http://dx.doi.org/10.2196/60436 UR - http://www.ncbi.nlm.nih.gov/pubmed/40073400 ID - info:doi/10.2196/60436 ER - TY - JOUR AU - Kuipers, M. Ellen A. AU - Timmerman, G. Josien AU - van Det, J. Marc AU - Vollenbroek-Hutten, R. Miriam M. PY - 2025/3/5 TI - Feasibility and Links Between Emotions, Physical States, and Eating Behavior in Patients After Metabolic Bariatric Surgery: Experience Sampling Study JO - JMIR Form Res SP - e60486 VL - 9 KW - feasibility KW - experience sampling methodology KW - metabolic bariatric surgery KW - eating behavior KW - positive and negative affect KW - physical states KW - contextual factors KW - mobile phone N2 - Background: Lifestyle modification is essential to achieve and maintain successful outcomes after metabolic bariatric surgery (MBS). Emotions, physical states, and contextual factors are considered important determinants of maladaptive eating behavior, emphasizing their significance in understanding and addressing weight management. In this context, experience sampling methodology (ESM) offers promise for measuring lifestyle and behavior in the patient?s natural environment. Nevertheless, there is limited research on its feasibility and association among emotions and problematic eating behavior within the population after MBS. Objective: This study aimed to examine the feasibility of ESM in the population after MBS regarding emotions, physical states, contextual factors, and problematic eating behavior, and to explore the temporal association among these variables. Methods: An experience sampling study was conducted in which participants rated their current affect (positive and negative), physical states (disgust, boredom, fatigue, and hunger), contextual factors (where, with whom, and doing what), and problematic eating behavior (ie, grazing, dietary relapse, craving, and binge eating) via smartphone-based ESM questionnaires at 6 semirandom times daily for 14 consecutive days. Feasibility was operationalized as the study?s participation rate and completion rate, compliance in answering ESM questionnaires, and response rates per day. At the end of the study period, patients reflected on the feasibility of ESM in semistructured interviews. Generalized estimation equations were conducted to examine the temporal association between emotions, physical states, contextual factors, and problematic eating behavior. Results: In total, 25 out of 242 participants consented to participate, resulting in a study participation rate of 10.3%. The completion rate was 83%. Overall compliance was 57.4% (1072/1868), varying from 13% (11/84) to 89% (75/84) per participant. Total response rates per day decreased from 65% (90/138) to 52% (67/130) over the 14-day study period. According to the interviews, ESM was considered feasible and of added value. Temporal associations were found for hunger and craving (odds ratio 1.04, 95% CI 1.00-1.07; P=.03), and for positive affect and grazing (odds ratio 1.61, 95% CI 1.03-2.51; P=.04). Conclusions: In this exploratory study, patients after MBS were not amenable to participate. Only a small number of patients were willing to participate. However, those who participated found it feasible and expressed satisfaction with it. Temporal associations were identified between hunger and craving, as well as between positive affect and grazing. However, no clear patterns were observed among emotions, physical states, context, and problematic eating behaviors. UR - https://formative.jmir.org/2025/1/e60486 UR - http://dx.doi.org/10.2196/60486 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053719 ID - info:doi/10.2196/60486 ER - TY - JOUR AU - Toh, Hui Siao AU - Davis, Courtney AU - Bte Khaider, Khairunisa AU - Ong, Quan Zhi AU - Lim, Kai Ethel Jie AU - Chew, Elaine Chu Shan PY - 2025/3/5 TI - Codevelopment of an mHealth App With Health Care Providers, Digital Health Experts, Community Partners, and Families for Childhood Obesity Management: Protocol for a Co-Design Process JO - JMIR Res Protoc SP - e59238 VL - 14 KW - childhood obesity KW - mHealth KW - mobile health KW - co-design KW - IDEAS framework N2 - Background: Childhood obesity is increasing in Singapore, with most cases persisting into adulthood and leading to poor health outcomes. The current evidence for childhood obesity interventions shows a clear dose-response effect, where effectiveness improves with an increasing number of treatment hours. A minimum threshold of ?26 hours over a 2- to 12-month period is required to achieve significant outcomes. The Kick Start Move Smart program is the first online community-based multidisciplinary program to treat pediatric obesity in Singapore. It has demonstrated feasibility and acceptability, with 70% of participants completing the recommended ?26 hours of intervention. Preliminary data show significantly lower BMI and improved quality of life in participants compared to controls. Successful families are positive outliers who developed strategies for health in the context of an obesogenic environment. This positive outlier approach indicates that solutions to challenges that a community faces exist within certain individual members, and these strategies can be generalized and promoted to improve the health of others in the same community. A mobile health (mHealth) app targeting parents is a critical missing link in the currently available interventions to support parental self-management of childhood obesity. Using a combination of behavioral theory and user-centered design approaches is important for designing mHealth apps. One recommended framework is Integrate, Design, Assess, and Share (IDEAS), which aims to facilitate the development of more effective interventions by engaging perspectives from different stakeholders. Objective: This study aims to (1) describe the co-design protocol of an mHealth app using the IDEAS framework as a low-intensity intervention or as an adjunct to more intensive existing pediatric obesity interventions and (2) assess the usability, acceptability, and engagement of the app by parents. Methods: A clinician-led co-design approach will be undertaken with a multidisciplinary team using the IDEAS framework. Phase 1 involves stakeholder engagement and the formation of a core committee and a parent advisory board. Phase 2 involves developing the app content through focus group and expert panel discussions. Phase 3 involves developing a prototype app and gathering feedback. Phase 4 involves piloting the minimum viable product by parent users and evaluating its effectiveness through interviews and questionnaires. Results: In April 2023, a parent advisory board was formed, and stakeholders were engaged as part of phase 1. Phases 2 and 3 were completed in June 2024. Focus group discussions were held with the parent advisory board and stakeholders to identify family strategies and patient-centric outcomes and provide feedback on the app. As of January 2025, the app is complete, and we are now in the middle of data collection from participants. Participants will provide feedback to the research team, and the app will be updated accordingly. Conclusions: An evidence-based, theory-driven mHealth app developed using a structured design framework can bridge the gap in delivering multidisciplinary care in community settings for families with overweight children. International Registered Report Identifier (IRRID): DERR1-10.2196/59238 UR - https://www.researchprotocols.org/2025/1/e59238 UR - http://dx.doi.org/10.2196/59238 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053786 ID - info:doi/10.2196/59238 ER - TY - JOUR AU - Dupuis, Roxanne AU - Musicus, A. Aviva AU - Edghill, Brittany AU - Keteku, Emma AU - Bragg, A. Marie PY - 2025/2/28 TI - How TikTok Influencers Disclose Food and Beverage Brand Partnerships: Descriptive Study JO - J Med Internet Res SP - e60891 VL - 27 KW - social media KW - social media marketing KW - social media influencer KW - food and beverage marketing KW - adolescent health N2 - Background: Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. Objective: This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. Methods: We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92%, and average pairwise Cohen ? was 0.82. Results: Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video?s caption was the most common disclosure method (n=182, 28.1%). Six types of caption hashtags were used to disclose brand relationships, including #[brandname] (n=63, 9.7%) and #ad (n=30, 4.6%). Only 1 video (0.2%) made use of TikTok?s official disclosure label and only 1 video (0.2%) verbally mentioned a contractual agreement with a brand. Conclusions: Among the food and beverage videos with disclosures we identified, the most frequently used mechanism?tagging the brand?did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children?s Food and Beverage Advertising Initiative?the largest self-regulatory pledge to reduce unhealthy food marketing?to include older adolescents, who are heavily targeted by food and beverage companies on social media. UR - https://www.jmir.org/2025/1/e60891 UR - http://dx.doi.org/10.2196/60891 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053812 ID - info:doi/10.2196/60891 ER - TY - JOUR AU - Pickard, Abigail AU - Edwards, Katie AU - Farrow, Claire AU - Haycraft, Emma AU - Blissett, Jacqueline PY - 2025/2/27 TI - Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study JO - JMIR Form Res SP - e66807 VL - 9 KW - pediatric KW - paediatric KW - child KW - child eating KW - parent feeding KW - parent KW - ecological momentary assessment KW - mHealth KW - mobile health KW - mobile app KW - application KW - smartphone KW - digital KW - digital health KW - digital technology KW - digital intervention N2 - Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents? feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers? compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children?s eating occasions and parents? feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 ?full? days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents? involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 UR - https://formative.jmir.org/2025/1/e66807 UR - http://dx.doi.org/10.2196/66807 ID - info:doi/10.2196/66807 ER - TY - JOUR AU - Perez Ramirez, Alejandra AU - Ortega, Adrian AU - Stephenson, Natalie AU - Muñoz Osorio, Angel AU - Kazak, Anne AU - Phan, Thao-Ly PY - 2025/2/11 TI - mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study JO - JMIR Form Res SP - e60495 VL - 9 KW - obesity KW - user testing KW - mHealth KW - mobile health KW - Spanish KW - child KW - rural population N2 - Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform?the Healthy Lifestyle (Nemours Children?s Health) dashboard?was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100%) selected the same dashboard icon and 71% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. UR - https://formative.jmir.org/2025/1/e60495 UR - http://dx.doi.org/10.2196/60495 UR - http://www.ncbi.nlm.nih.gov/pubmed/39932772 ID - info:doi/10.2196/60495 ER - TY - JOUR AU - Bennett, Grace AU - Yang, Shuhua AU - Bardon, A. Laura AU - Timon, M. Claire AU - Gibney, R. Eileen PY - 2025/2/7 TI - Expansion and Assessment of a Web-Based 24-Hour Dietary Recall Tool, Foodbook24, for Use Among Diverse Populations Living in Ireland: Comparative Analysis JO - Online J Public Health Inform SP - e52380 VL - 17 KW - dietary assessment KW - ethnic diets KW - dietary records KW - web-based tools KW - diverse intake N2 - Background: Currently, the methods used to collect dietary intake data in Ireland are inflexible to the needs of certain populations, who are poorly represented in nutrition and health data as a result. As the Irish population is becoming increasingly diverse, there is an urgent need to understand the habitual food intake and diet quality of multiple population subgroups, including different nationalities and ethnic minorities, in Ireland. Foodbook24 is an existing web-based 24-hour dietary recall tool, which has previously been validated for use within the general Irish adult population. Because of its design, Foodbook24 can facilitate the improved inclusion of dietary intake assessment in Ireland. Objective: We aimed to examine the suitability of expanding the Foodbook24 tool, improving the reliability and accuracy of dietary intake data collected among prominent nationalities in Ireland. Methods: This study consisted of three distinct parts: (1) expansion of Foodbook24, (2) testing its usability (ie, acceptability study), and (3) examining the accuracy (ie, comparison study) of the updated Foodbook24 tool. To expand Foodbook24, national survey data from Brazil and Poland were reviewed and commonly consumed food items were added to the food list. All foods were translated into Polish and Portuguese. The acceptability study used a qualitative approach whereby participants provided a visual record of their habitual diet. The comparison study consisted of one 24-hour dietary recall using Foodbook24 and one interviewer-led recall completed on the same day, repeated again 2 weeks later. Comparison study data were analyzed using Spearman rank correlations, Mann-Whitney U tests, and ? coefficients. Results: The expansion of the Foodbook24 food list resulted in 546 additional foods. The acceptability study reported that 86.5% (302/349) of foods listed by participants were available in the updated food list. From the comparison study, strong and positive correlations across 8 food groups (44% of a total of 18 food groups) and 15 nutrients (58% of a total of 26 nutrients) were identified (r=0.70-0.99). Only intakes of potatoes and potato dishes and nuts, herbs, and seeds significantly differed across methods of assessment, where correlations across these food groups were low (r=0.56 and r=0.47, respectively). The incidence of food omissions varied across samples, with Brazilian participants omitting a higher percentage of foods in self-administered recalls than other samples (6/25, 24% among the Brazilian vs 5/38, 13% among the Irish cohort). Conclusions: The updated food list is representative of most foods consumed by Brazilian, Irish, and Polish adults in Ireland. Dietary intake data reported in Foodbook24 are not largely different from food groups and nutrient intakes reported via traditional methods. This study has demonstrated that Foodbook24 may be appropriate for use in future research investigating the dietary intakes of Brazilian, Irish, and Polish groups in Ireland. UR - https://ojphi.jmir.org/2025/1/e52380 UR - http://dx.doi.org/10.2196/52380 UR - http://www.ncbi.nlm.nih.gov/pubmed/39919284 ID - info:doi/10.2196/52380 ER - TY - JOUR AU - Beuken, JM Maik AU - Kleynen, Melanie AU - Braun, Susy AU - Van Berkel, Kees AU - van der Kallen, Carla AU - Koster, Annemarie AU - Bosma, Hans AU - Berendschot, TJM Tos AU - Houben, JHM Alfons AU - Dukers-Muijrers, Nicole AU - van den Bergh, P. Joop AU - Kroon, A. Abraham AU - AU - Kanera, M. Iris PY - 2025/2/5 TI - Identification of Clusters in a Population With Obesity Using Machine Learning: Secondary Analysis of The Maastricht Study JO - JMIR Med Inform SP - e64479 VL - 13 KW - Maastricht Study KW - participant clusters KW - cluster analysis KW - factor probabilistic distance clustering KW - FPDC algorithm KW - statistically equivalent signature KW - SES feature selection KW - unsupervised machine learning KW - obesity KW - hypothesis free KW - risk factor KW - physical inactivity KW - poor nutrition KW - physical activity KW - chronic disease KW - type 2 diabetes KW - diabetes KW - heart disease KW - long-term behavior change N2 - Background: Modern lifestyle risk factors, like physical inactivity and poor nutrition, contribute to rising rates of obesity and chronic diseases like type 2 diabetes and heart disease. Particularly personalized interventions have been shown to be effective for long-term behavior change. Machine learning can be used to uncover insights without predefined hypotheses, revealing complex relationships and distinct population clusters. New data-driven approaches, such as the factor probabilistic distance clustering algorithm, provide opportunities to identify potentially meaningful clusters within large and complex datasets. Objective: This study aimed to identify potential clusters and relevant variables among individuals with obesity using a data-driven and hypothesis-free machine learning approach. Methods: We used cross-sectional data from individuals with abdominal obesity from The Maastricht Study. Data (2971 variables) included demographics, lifestyle, biomedical aspects, advanced phenotyping, and social factors (cohort 2010). The factor probabilistic distance clustering algorithm was applied in order to detect clusters within this high-dimensional data. To identify a subset of distinct, minimally redundant, predictive variables, we used the statistically equivalent signature algorithm. To describe the clusters, we applied measures of central tendency and variability, and we assessed the distinctiveness of the clusters through the emerged variables using the F test for continuous variables and the chi-square test for categorical variables at a confidence level of ?=.001 Results: We identified 3 distinct clusters (including 4128/9188, 44.93% of all data points) among individuals with obesity (n=4128). The most significant continuous variable for distinguishing cluster 1 (n=1458) from clusters 2 and 3 combined (n=2670) was the lower energy intake (mean 1684, SD 393 kcal/day vs mean 2358, SD 635 kcal/day; P<.001). The most significant categorical variable was occupation (P<.001). A significantly higher proportion (1236/1458, 84.77%) in cluster 1 did not work compared to clusters 2 and 3 combined (1486/2670, 55.66%; P<.001). For cluster 2 (n=1521), the most significant continuous variable was a higher energy intake (mean 2755, SD 506.2 kcal/day vs mean 1749, SD 375 kcal/day; P<.001). The most significant categorical variable was sex (P<.001). A significantly higher proportion (997/1521, 65.55%) in cluster 2 were male compared to the other 2 clusters (885/2607, 33.95%; P<.001). For cluster 3 (n=1149), the most significant continuous variable was overall higher cognitive functioning (mean 0.2349, SD 0.5702 vs mean ?0.3088, SD 0.7212; P<.001), and educational level was the most significant categorical variable (P<.001). A significantly higher proportion (475/1149, 41.34%) in cluster 3 received higher vocational or university education in comparison to clusters 1 and 2 combined (729/2979, 24.47%; P<.001). Conclusions: This study demonstrates that a hypothesis-free and fully data-driven approach can be used to identify distinguishable participant clusters in large and complex datasets and find relevant variables that differ within populations with obesity. UR - https://medinform.jmir.org/2025/1/e64479 UR - http://dx.doi.org/10.2196/64479 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64479 ER - TY - JOUR AU - Bragg, A. Marie AU - Lutfeali, Samina AU - Gabler, Godoy Daniela AU - Quintana Licona, A. Diego AU - Harris, L. Jennifer PY - 2025/1/31 TI - Latinx and White Adolescents? Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study JO - J Med Internet Res SP - e53188 VL - 27 KW - Latinx KW - Hispanic KW - adolescents KW - marketing KW - celebrities KW - Spanish KW - advertisements KW - products KW - brands KW - food KW - unhealthy KW - beverages KW - diet KW - nutrition KW - consumers KW - intention KW - purchasing KW - attitudes KW - perceptions KW - preferences KW - youth N2 - Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents? preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants? ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement??liking;? following; commenting; tagging a friend). Results: Latinx (n=436; 48.3%) and White (n=467; 51.7%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps?.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of ?liking? advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. UR - https://www.jmir.org/2025/1/e53188 UR - http://dx.doi.org/10.2196/53188 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53188 ER - TY - JOUR AU - Perez-Bootello, Javier AU - Berna-Rico, Emilio AU - Abbad-Jaime de Aragon, Carlota AU - Cova-Martin, Ruth AU - Goni, Leticia AU - Ballester-Martinez, Asuncion AU - Jaen-Olasolo, Pedro AU - Mehta, Nehal AU - Gelfand, M. Joel AU - Martinez-Gonzalez, Angel Miguel AU - Gonzalez-Cantero, Alvaro PY - 2025/1/29 TI - Impact of the Mediterranean Diet on Patients With Psoriasis: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e64277 VL - 14 KW - psoriasis KW - Mediterranean diet KW - MedDiet KW - nutritional intervention KW - olive oil KW - inflammatory disease KW - Impact of the Mediterranean Diet on Patients with Psoriasis KW - MEDIPSO KW - dietary intervention KW - methodological analysis KW - randomized controlled trial KW - RCT KW - clinical trial KW - nutrition KW - diet KW - Europe N2 - Background: Psoriasis is an inflammatory disease primarily treated through molecular-targeted therapies. However, emerging evidence suggests that dietary interventions may also play a role in managing inflammation associated with this condition. The Mediterranean diet (MedDiet), prevalent in southern European countries, has been widely recognized for its ability to reduce cardiovascular mortality, largely due to its anti-inflammatory properties. This anti-inflammatory potential has prompted interest in exploring the MedDiet?s role in immune-mediated diseases, including psoriasis. Observational studies have indicated potential benefits, such as reductions in the Psoriasis Area and Severity Index. However, there is a need for well-designed clinical trials to address the methodological limitations of these studies and to establish specific dietary recommendations for psoriasis. Objective: This study aims to evaluate the impact of an intensive dietary intervention based on the MedDiet in patients with psoriasis. The study will assess the effects of this intervention on skin involvement, metabolic parameters, and inflammatory cytokines. In addition, the emotional well-being and quality of life of participants will be evaluated using validated questionnaires. A methodological analysis will also be conducted to enhance the design of future large-scale clinical trials. Methods: An open-label, single-blinded (evaluator) randomized controlled trial was designed to assess the impact of a high-intensity MedDiet intervention in patients with mild-to-moderate psoriasis. A total of 38 patients will be randomly assigned into 2 groups?an intervention group receiving the MedDiet intervention and a control group receiving standard care. The intervention group will participate in dietary education sessions aimed at adopting the MedDiet over 4 months, with monthly monitoring by experienced nutritionists. Participants will receive 500 mL of extra virgin olive oil per week, along with informative materials, recipes, and weekly menus. In contrast, the control group will receive standard low-fat diet recommendations without nutritionist monitoring. All participants will undergo a baseline visit, a 2-month follow-up visit, and a final visit at 4 months. Blood tests will be conducted at the beginning and end of the study. This study protocol was approved by the Institutional Review Board of the Hospital Ramón y Cajal (Madrid) in July 2023. Results: Enrollment concluded in October 2024, with data collection set to finish by February 2025. The findings will be presented at national and international conferences and published in peer-reviewed journals. Conclusions: This protocol outlines the design of a clinical trial that implements the MedDiet in patients with psoriasis to evaluate its benefits on skin involvement, systemic inflammation, and quality of life. Trial Registration: ClinicalTrials.gov NCT06257641; https://clinicaltrials.gov/study/NCT06257641 International Registered Report Identifier (IRRID): DERR1-10.2196/64277 UR - https://www.researchprotocols.org/2025/1/e64277 UR - http://dx.doi.org/10.2196/64277 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64277 ER - TY - JOUR AU - Zuair, Areeg AU - Alhowaymel, M. Fahad AU - Jalloun, A. Rola AU - Alzahrani, S. Naif AU - Almasoud, H. Khalid AU - Alharbi, H. Majdi AU - Alnawwar, K. Rayan AU - Alluhaibi, N. Mohammed AU - Alharbi, S. Rawan AU - Aljohan, M. Fatima AU - Alhumaidi, N. Bandar AU - Alahmadi, A. Mohammad PY - 2025/1/24 TI - Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non?Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study JO - JMIR Pediatr Parent SP - e67213 VL - 8 KW - adolescent obesity KW - macronutrient education KW - cardiovascular fitness KW - body composition KW - health literacy KW - body image KW - macronutrient KW - educational KW - obesity KW - weight KW - overweight KW - fitness KW - nutrition KW - diet KW - patient education KW - student KW - school KW - youth KW - adolescent KW - teenager KW - metabolic KW - eating KW - physical activity KW - exercise N2 - Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non?weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non?weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and ?² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial ?²=0.268). There was no significant change in students? body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non?weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. UR - https://pediatrics.jmir.org/2025/1/e67213 UR - http://dx.doi.org/10.2196/67213 ID - info:doi/10.2196/67213 ER - TY - JOUR AU - Hendrie, A. Gilly AU - Baird, L. Danielle AU - James-Martin, Genevieve AU - Brindal, Emily AU - Brooker, G. Paige PY - 2025/1/15 TI - Weight Loss Patterns and Outcomes Over 12 Months on a Commercial Weight Management Program (CSIRO Total Wellbeing Diet Online): Large-Community Cohort Evaluation Study JO - J Med Internet Res SP - e65122 VL - 27 KW - obesity KW - obesity management KW - weight loss KW - internet-based intervention, weight management N2 - Background: A greater understanding of the effectiveness of digital self-management programs and their ability to support longer-term weight loss is needed. Objective: This study aimed to explore the total weight loss and patterns of weight loss of CSIRO (Commonwealth Scientific and Industrial Research Organisation) Total Wellbeing Diet Online members during their first 12 months of membership and examine the patterns of platform use associated with greater weight loss. Methods: Participants were Australian adults who joined the program between October 2014 and June 2022 and were classified as longer-term members, meaning they completed at least 12 weeks of the program, had baseline and 12-week weight data, and had a paid membership of ?1 year (N=24,035). Weight loss and percentage of starting body weight loss were calculated at 3, 6, 9, and 12 months using 3 statistical approaches: (1) multiple imputations method, (2) all available data, and (3) complete data only. Among members with complete data (6602/24,035, 27.5%), patterns of weight loss and gain were examined, and how this related to total weight loss and platform use was explored. Results: Members were mostly female (19,972/24,035, 83.09%), aged 31 to 50 years (9986/24,035, 41.5%) or 51 to 70 years (12,033/24,035, 50.06%), and most members were classified as overweight or obese (23,050/24,035, 95.9%). Using multiple imputations, the average estimated weight loss was 5.9 (SE 0.0245) kg at 12 weeks, 6.7 (SE 0.0348) kg at 6 months, 6.2 (SE 0.0400) kg at 9 months, and 5.5 (SE 0.0421) kg at 12 months. At 12 months, more than half the members (12,573/24,035, 52.3%) were at least 5% below their starting body weight and 1 in 4 (5865/24,035, 24.4%) were at least 10% below their starting body weight. In the subsample with complete data, the average weight loss at 12 months was 7.8 kg. The most common (961/6602, 14.56% members) weight loss pattern over the first 12 months was 6 months of weight loss, followed by 6 months of weight maintenance. This group had an average weight loss of 10.6 kg at 12 months (11.9% of their starting body weight). In a subgroup of participants who consistently lost weight over the 12-month period (284/6602, 4.3% of the sample), weight loss reached up to 22.3 kg (21.7% of their starting body weight). Weekly platform use was positively associated with total weight loss (r=0.287; P<.001). Members who used the platform >30 times per week (approximately >4 times/d) were more likely to lose weight in the first 6 months of the program. Conclusions: This commercial weight loss program was shown to be effective, with 1 in 2 members achieving clinically significant results after 1 year. Greater engagement with the platform was associated with consecutive periods of weight loss and greater weight loss success overall. UR - https://www.jmir.org/2025/1/e65122 UR - http://dx.doi.org/10.2196/65122 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65122 ER - TY - JOUR AU - Leung, May May AU - Mateo, F. Katrina AU - Dublin, Marlo AU - Harrison, Laura AU - Verdaguer, Sandra AU - Wyka, Katarzyna PY - 2025/1/15 TI - Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial JO - JMIR Form Res SP - e58460 VL - 9 KW - childhood obesity KW - preadolescents KW - racial and ethnic minority populations KW - dietary behaviors KW - BMI KW - digital health N2 - Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 3.0 on a 5-point Likert scale), with 60% (6/10) favoring a blended learning approach. Conclusions: In total, 68 essential competencies are required for pediatricians to manage children who are malnourished. The online course effectively improved knowledge acquisition among health care professionals, with high participant satisfaction and approval of the e-learning environment. UR - https://mededu.jmir.org/2024/1/e53151 UR - http://dx.doi.org/10.2196/53151 ID - info:doi/10.2196/53151 ER - TY - JOUR AU - Wang, Xi AU - Wang, Suyuan AU - Zhong, Lingyu AU - Zhang, Chenghui AU - Guo, Yanhong AU - Li, Mingxia AU - Zhao, Li AU - Ji, Shuming AU - Pan, Junjie AU - Wu, Yunhong PY - 2024/10/28 TI - Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e47104 VL - 12 KW - weight loss KW - obesity KW - body fat KW - food replacement product KW - meal replacement KW - weight KW - obese KW - RCT KW - randomized KW - mHealth KW - mobile health KW - mobile app KW - mobile application KW - mobile phone N2 - Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. Results: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021630; https://www.chictr.org.cn/showproj.html?proj=36183 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-048106 UR - https://mhealth.jmir.org/2024/1/e47104 UR - http://dx.doi.org/10.2196/47104 ID - info:doi/10.2196/47104 ER - TY - JOUR AU - Li, Huilun AU - Lu, Zhaohui AU - Zhang, Erliang AU - Zhang, Jie AU - Cui, Shuheng AU - Takahashi, Masaki AU - Xiang, Mi PY - 2024/10/23 TI - Meal Timing and Depression Among Chinese Children and Adolescents: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e54275 VL - 10 KW - mental health KW - meal timing KW - chrononutrition KW - depression KW - mhealth KW - meal time KW - children KW - adolescent KW - cross-sectional study KW - China KW - schedule of meal KW - metabolic disorder KW - correlation KW - survey KW - breakfast skipping KW - food intake KW - daily eating KW - analysis KW - logistic regression N2 - Background: Depression in children and adolescents is a rising concern in China. Dietary behavior is a critical determinant of mental health. Meal timing, or the schedule of meal consumption, has been related to several metabolic disorders. However, the effect of meal timing on mental health is scarce, particularly in children and adolescents who are in a critical period of physical and psychological development. Objective: This research examined the relationship between meal timing and depression in children and adolescents in China. Methods: Children and adolescents from grades 1 to 9 were recruited from 16 districts in Shanghai, China, from January 3 to January 21, 2020. Ten schools attended the study. A survey was distributed to the students and their parents to collect demographic and health-related information. Depression was measured by the Children?s Depression Inventory-Short Form. Breakfast consumption was analyzed as a binary outcome. Participants were defined as breakfast consumers if they never skipped breakfast during the week. They were otherwise defined as breakfast skippers if they skipped breakfast at least once per week. A similar categorization was applied to analyze food intake proximal to bed. Daily eating windows were calculated using the last food intake time frame?the first food intake time frame. Participants were classified into eating window groups of less than 10 hours, 10-12 hours, and more than 12 hours. A logistic regression model was used to compute the odds ratio (OR) and 95% CI. Results: A total of 6874 participants were included in the analysis. Participants who skipped breakfast were associated with a 2.70 times higher occurrence of depression (OR 2.70, 95% CI 2.24?3.26; P<.001). The prevalence of depression was 1.28 times higher in participants who ate before bed than in those who never ate before bed (OR 1.28, 95% CI 1.08?1.50; P<.001). The occurrence of depression was 1.37 times higher if the eating time window was shorter than 10 hours (OR 1.37, 95% CI 1.08?1.73; P=.009) and 1.23 times higher if the eating time window was longer than 12 hours (OR 1.23, 95% CI 1.01?1.50; P=.004). The lowest occurrence of depression was observed at 11.5 hours. Subgroup analysis showed that such relationships remained significant in adolescents aged 10 years or older. In children, only skipping breakfast was associated with a higher odds of depression (OR 2.77, 95% CI 1.94?3.96; P<.001). Conclusions: Breakfast skipping and eating before bed significantly increase the occurrence of depression. The optimal daily eating window to lower the occurrence of depression is 11.5 hours in children and adolescents. Daily eating windows longer than 12 hours or shorter than 10 hours are associated with an elevated occurrence of depression. Current findings advocate evidence-based dietary strategies to prevent and treat depression in children and adolescents. UR - https://publichealth.jmir.org/2024/1/e54275 UR - http://dx.doi.org/10.2196/54275 ID - info:doi/10.2196/54275 ER - TY - JOUR AU - Aljaloud, Khalid AU - Al-Barha, Naif AU - Noman, Abeer AU - Aldayel, Abdulaziz AU - Alsharif, Yahya AU - Alshuwaier, Ghareeb PY - 2024/10/17 TI - Dynamics of Blood Lipids Before, During, and After Diurnal Fasting in Inactive Men: Quasi-Experimental Study JO - Interact J Med Res SP - e56207 VL - 13 KW - cardiovascular diseases KW - cardiovascular risk factors KW - lipids KW - glucose measurement KW - fasting KW - Ramadan KW - body composition N2 - Background: There is a lack of investigation into the dynamics of blood lipids before, during, and after diurnal fasting, especially in inactive men. Objective: This study determined dynamic changes in blood lipids in inactive men before, during, and after they underwent diurnal fasting. Methods: A total of 44 young men aged a mean 27.6 (SD 5.8) years were recruited to evaluate their habitual physical activity and diet using a questionnaire developed for this study. Body composition was evaluated using a bioelectrical impedance analysis machine (Tanita BC-980). An 8-ml blood sample was collected to evaluate blood lipids and glucose. All measurements were taken 2-3 days before Ramadan, during Ramadan (at week 2 and week 3), and 1 month after Ramadan. A 1-way repeated measures ANOVA was used to compare the measured variables before, during, and after the month of Ramadan. When a significant difference was found, post hoc testing was used. Differences were considered significant at P<.05. Results: There was a significant reduction in low-density lipoprotein during Ramadan compared to before and after Ramadan (83.49 mg/dl at week 3 vs 93.11 mg/dl before Ramadan [P=.02] and 101.59 mg/dl after Ramadan [P=.007]). There were significant elevations in fasting blood glucose (74.60 mmol/L before Ramadan vs 81.52 mmol/L at week 3 [P=.03] and 86.51 mmol/L after Ramadan [P=.01]) and blood pressure (109 mm Hg before Ramadan vs 114 mm Hg after Ramadan; P=.02) reported during and even after the month of Ramadan, although both fasting blood glucose and blood pressure were within normal levels. Conclusions: Ramadan fasting could be an independent factor in reducing low-density lipoprotein. Further investigations are encouraged to clarify the impact of diurnal fasting on blood lipids in people with special conditions. UR - https://www.i-jmr.org/2024/1/e56207 UR - http://dx.doi.org/10.2196/56207 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56207 ER - TY - JOUR AU - Cassidy, Omni AU - Bragg, Marie AU - Elbel, Brian PY - 2024/10/17 TI - Virtual Reality?Based Food and Beverage Marketing: Potential Implications for Young People of Color, Knowledge Gaps, and Future Research Directions JO - JMIR Public Health Surveill SP - e62807 VL - 10 KW - virtual reality KW - VR KW - digital food and beverage marketing KW - obesity KW - marketing KW - food KW - consumption KW - beverage KW - immersive KW - market KW - consumer UR - https://publichealth.jmir.org/2024/1/e62807 UR - http://dx.doi.org/10.2196/62807 ID - info:doi/10.2196/62807 ER - TY - JOUR AU - Aubert, Morghane AU - Clavel, Céline AU - Le Scanff, Christine AU - Martin, Jean-Claude PY - 2024/10/15 TI - Intervention to Improve Well-Being, Nutrition, and Physical Activity in Adults: Experimental Study JO - JMIR Form Res SP - e47251 VL - 8 KW - mindfulness KW - well-being KW - affects KW - nutrition KW - physical activity KW - intervention KW - lifestyle habits KW - mindfulness exercises N2 - Background: Mindfulness improves well-being, improves emotional regulation, reduces impulses to eat, and is linked to increased physical activity. Mindfulness interventions usually focus on 1 aspect but do not offer an approach to holistically improving lifestyle. Objective: This study aims to address this gap by designing and evaluating a holistic mindfulness intervention. Methods: Committing to a 12-week intervention with 2-hour sessions without knowing whether you will enjoy it can be a hindrance for someone completely unfamiliar with mindfulness. For this reason, we decided to design a mindfulness intervention with short sessions over a reduced number of weeks. The aim is to enable novices to discover different aspects of mindfulness while at the same time offering a satisfactory practice for people who are already practicing mindfulness. We designed and evaluated a web-based mindfulness intervention in 5 sessions of 5 to 10 minutes each on well-being, diet, and physical activity to support a healthier lifestyle. The first 2 sessions focus on formal mindfulness meditation to enable novices to discover mindfulness and its main principles. Then there are 2 sessions about food. The first session about food aims to develop a sense of satisfaction with the food we eat and to focus our attention on new sensations. The second session about food aims to develop the ability to resist the lure of unhealthy foods. Finally, there is a session on physical activity. The aim is to develop a particular awareness of the body during movement, to increase satisfaction with physical activity, and to develop regular exercise. Results: In total, 32 participants completed the intervention. After the intervention, we observed decreases in negative affect, anxiety, and emotional distress, and an increase in dispositional mindfulness. There was no effect on reported healthy eating habits and physical activity habits. Few participants repeated the exercises as recommended. The majority of our participants were new to mindfulness. The majority of our participants reported being satisfied with the different sessions. A few minor difficulties were mentioned, mainly related to the environment in which the participants carried out the sessions. Only 1 session was less satisfactory for one-third of the participants. The session on resistance to unhealthy foods was formulated too strictly and the idea of banning certain foods was a hindrance for one-third of the participants. A reformulation is needed. Conclusions: The mindfulness exercises were well accepted and promoted a state of mindfulness. It would be interesting to provide easier technical access to the exercises via a mobile app so that they can be repeated easily. UR - https://formative.jmir.org/2024/1/e47251 UR - http://dx.doi.org/10.2196/47251 UR - http://www.ncbi.nlm.nih.gov/pubmed/39405102 ID - info:doi/10.2196/47251 ER - TY - JOUR AU - Jeong, Jinyoung AU - Lee, Seungjun AU - Lee, Kyeongmin AU - Kim, Seokjun AU - Park, Jaeyu AU - Son, Yejun AU - Lee, Hyeri AU - Lee, Hayeon AU - Kang, Jiseung AU - Rahmati, Masoud AU - Pizzol, Damiano AU - Smith, Lee AU - López Sánchez, F. Guillermo AU - Dragioti, Elena AU - Fond, Guillaume AU - Boyer, Laurent AU - Woo, Selin AU - Rhee, Youl Sang AU - Yon, Keon Dong PY - 2024/10/9 TI - National Trends in the Prevalence of Self-Perceived Overweight Among Adolescents Between 2005 and 2022: Nationwide Representative Study JO - JMIR Public Health Surveill SP - e57803 VL - 10 KW - self-perceived overweight KW - trend KW - prevalence KW - South Korea KW - adolescent N2 - Background: Despite several studies on self-evaluation of health and body shape, existing research on the risk factors of self-perceived overweight is insufficient, especially during the COVID-19 pandemic. Objective: This study aims to identify the risk factors affecting self-perceived overweight and examine how the prevalence of self-perceived overweight has changed before and during the COVID-19 pandemic. Specifically, we analyzed the impact of altered lifestyles due to COVID-19 on this phenomenon. Methods: The data used in the study were obtained from middle and high school students who participated in the Korean Youth Risk Behavior Web-based Survey (N=1,189,586). This survey was a 2-stage stratified cluster sampling survey representative of South Korean adolescents. We grouped the survey results by year and estimated the slope in the prevalence of self-perceived overweight before and during the pandemic using weighted linear regression, as well as the prevalence tendencies of self-perceived overweight according to various risk factors. We used prevalence ratios to identify the risk factors for self-perceived overweight. In addition, we conducted comparisons of risk factors in different periods to identify their associations with the COVID-19 pandemic. Results: The prevalence of self-perceived overweight was much higher than BMI-based overweight among 1,189,586 middle and high school participants (grade 7-12) from 2005 to 2022 (female participants: n=577,102, 48.51%). From 2005 to 2019 (prepandemic), the prevalence of self-perceived overweight increased (?=2.80, 95% CI 2.70-2.90), but from 2020 to 2022 (pandemic) it decreased (?=?0.53, 95% CI ?0.74 to ?0.33). During the pandemic, individuals with higher levels of stress or lower household economic status exhibited a more substantial decrease in the rate of self-perceived overweight. The prevalence of self-perceived overweight tended to be higher among individuals with poor academic performance, lower economic status, poorer subjective health, and a higher stress level. Conclusions: Our nationwide study, conducted over 18 years, indicated that self-perceived overweight decreased during the COVID-19 period while identifying low academic performance and economic status as risk factors. These findings suggest the need for policies and facilities to address serious dieting and body dissatisfaction resulting from self-perceived overweight by developing counseling programs for adolescents with risk factors such as lower school performance and economic status. UR - https://publichealth.jmir.org/2024/1/e57803 UR - http://dx.doi.org/10.2196/57803 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382947 ID - info:doi/10.2196/57803 ER - TY - JOUR AU - Zhang, Zeyu AU - Li, Sijia AU - Zhai, Zidan AU - Qiu, Ting AU - Zhou, Yu AU - Zhang, Heng PY - 2024/10/9 TI - Temporal Trends in the Prevalence of Child Undernutrition in China From 2000 to 2019, With Projections of Prevalence in 2030: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e58564 VL - 10 KW - child growth failure KW - undernutrition KW - stunting KW - wasting KW - underweight KW - trends KW - projections N2 - Background: Although the problem of malnutrition among children in China has greatly improved in recent years, there is a gap compared to developed countries, and there are differences between provinces. Research on long-term comprehensive trends in child growth failure (CGF) in China is needed for further improvement. Objective: The purpose of this study was to examine trends in stunting, wasting, and underweight among children younger than 5 years in China from 2000 to 2019, and predict CGF till 2030. Methods: We conducted a cross-sectional analysis using data from the local burden of disease (LBD) database. Using Joinpoint Regression Software, we examined trends in CGF among children younger than 5 years in China from 2000 to 2019, and predicted the trends of prevalence in 2030, using the Holt-Winters model with trends but without seasonal components. The assessment was performed with Stata 17 (StataCorp). Data were analyzed from October 17, 2023, to November 22, 2023. Results: In 2019, the prevalences of stunting, wasting, and underweight decreased to 12%, 3%, and 4%, respectively (decreases of 36.9%, 25.0%, and 42.9%, respectively, compared with the values in 2000). The prevalence of CGF decreased rapidly from 2000 to 2010, and the downward trend slowed down after 2010. Most provinces had stagnated processes of trends after 2017. The age group with the highest stunting prevalence was children aged 1 to 4 years, and the highest prevalence of wasting and underweight was noted in early neonatal infants. From 2000 to 2019, the prevalence of CGF declined in all age groups of children. The largest relative decrease in stunting and underweight was noted in children aged 1 to 4 years, and the largest decrease in wasting was noted in early neonatal infants. The prevalences of stunting, wasting, and underweight in China are estimated to decrease to 11.4%, 3.2%, and 4.1%, respectively, by 2030. China has nationally met the World Health Organization?s Global Nutrition Targets for 2030 for stunting but not for wasting. Conclusions: This study provides data on the prevalence and trends of CGF among children younger than 5 years and reports declines in CGF. There remain areas with slow progress in China. Most units have achieved the goal for stunting prevalence but not wasting prevalence. UR - https://publichealth.jmir.org/2024/1/e58564 UR - http://dx.doi.org/10.2196/58564 UR - http://www.ncbi.nlm.nih.gov/pubmed/39382950 ID - info:doi/10.2196/58564 ER - TY - JOUR AU - Fernandez-Lazaro, I. Cesar AU - Santamaría, Gema AU - Fernandez Milano, Annika AU - Martin-Vergel, I. Maria AU - Fernandez-Lazaro, Diego PY - 2024/10/4 TI - Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis JO - JMIR Mhealth Uhealth SP - e52424 VL - 12 KW - mobile apps KW - mHealth KW - mobile health KW - app KW - nutritional KW - nutrition KW - dietary KW - eating KW - diet KW - food KW - lifestyle KW - Spain KW - Spanish KW - chronic diseases KW - chronic KW - review KW - quality KW - MARS KW - Mobile App Rating Scale KW - uMARS KW - user version of the Mobile App Rating Scale KW - assessment KW - mobile phone N2 - Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ?4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users. UR - https://mhealth.jmir.org/2024/1/e52424 UR - http://dx.doi.org/10.2196/52424 ID - info:doi/10.2196/52424 ER - TY - JOUR AU - Stankoski, Simon AU - Kiprijanovska, Ivana AU - Gjoreski, Martin AU - Panchevski, Filip AU - Sazdov, Borjan AU - Sofronievski, Bojan AU - Cleal, Andrew AU - Fatoorechi, Mohsen AU - Nduka, Charles AU - Gjoreski, Hristijan PY - 2024/9/26 TI - Controlled and Real-Life Investigation of Optical Tracking Sensors in Smart Glasses for Monitoring Eating Behavior Using Deep Learning: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e59469 VL - 12 KW - chewing detection KW - eating detection KW - smart glasses KW - automatic dietary monitoring KW - eating behavior N2 - Background: The increasing prevalence of obesity necessitates innovative approaches to better understand this health crisis, particularly given its strong connection to chronic diseases such as diabetes, cancer, and cardiovascular conditions. Monitoring dietary behavior is crucial for designing effective interventions that help decrease obesity prevalence and promote healthy lifestyles. However, traditional dietary tracking methods are limited by participant burden and recall bias. Exploring microlevel eating activities, such as meal duration and chewing frequency, in addition to eating episodes, is crucial due to their substantial relation to obesity and disease risk. Objective: The primary objective of the study was to develop an accurate and noninvasive system for automatically monitoring eating and chewing activities using sensor-equipped smart glasses. The system distinguishes chewing from other facial activities, such as speaking and teeth clenching. The secondary objective was to evaluate the system?s performance on unseen test users using a combination of laboratory-controlled and real-life user studies. Unlike state-of-the-art studies that focus on detecting full eating episodes, our approach provides a more granular analysis by specifically detecting chewing segments within each eating episode. Methods: The study uses OCO optical sensors embedded in smart glasses to monitor facial muscle activations related to eating and chewing activities. The sensors measure relative movements on the skin?s surface in 2 dimensions (X and Y). Data from these sensors are analyzed using deep learning (DL) to distinguish chewing from other facial activities. To address the temporal dependence between chewing events in real life, we integrate a hidden Markov model as an additional component that analyzes the output from the DL model. Results: Statistical tests of mean sensor activations revealed statistically significant differences across all 6 comparison pairs (P<.001) involving 2 sensors (cheeks and temple) and 3 facial activities (eating, clenching, and speaking). These results demonstrate the sensitivity of the sensor data. Furthermore, the convolutional long short-term memory model, which is a combination of convolutional and long short-term memory neural networks, emerged as the best-performing DL model for chewing detection. In controlled laboratory settings, the model achieved an F1-score of 0.91, demonstrating robust performance. In real-life scenarios, the system demonstrated high precision (0.95) and recall (0.82) for detecting eating segments. The chewing rates and the number of chews evaluated in the real-life study showed consistency with expected real-life eating behaviors. Conclusions: The study represents a substantial advancement in dietary monitoring and health technology. By providing a reliable and noninvasive method for tracking eating behavior, it has the potential to revolutionize how dietary data are collected and used. This could lead to more effective health interventions and a better understanding of the factors influencing eating habits and their health implications. UR - https://mhealth.jmir.org/2024/1/e59469 UR - http://dx.doi.org/10.2196/59469 UR - http://www.ncbi.nlm.nih.gov/pubmed/39325528 ID - info:doi/10.2196/59469 ER - TY - JOUR AU - Gansterer, Alina AU - Moliterno, Paula AU - Neidenbach, Rhoia AU - Ollerieth, Caroline AU - Czernin, Sarah AU - Scharhag, Juergen AU - Widhalm, Kurt PY - 2024/9/19 TI - Effect of a Web-Based Nutritional and Physical Activity Intervention With Email Support (the EDDY Program) on Primary School Children?s BMI Z-Score During the COVID-19 Pandemic: Intervention Study JO - JMIR Pediatr Parent SP - e50289 VL - 7 KW - childhood obesity KW - BMI KW - prevention intervention KW - physical activity KW - nutrition KW - nutritional KW - school-based KW - web-based KW - COVID-19 KW - diet KW - child KW - childhood KW - children KW - pediatric KW - pediatrics KW - weight KW - obesity KW - obese KW - exercise KW - school KW - student KW - students KW - youth N2 - Background: COVID-19 mitigation measures enhanced increases in children?s weight and BMI due to decreased physical activity and increased energy intake. Overweight and obesity were major worldwide problems before the pandemic, and COVID-19 increased their severity even more. High BMI directly correlates with health disadvantages including cardiovascular diseases, musculoskeletal disorders, and mental health diseases. Therefore, it is vitally important to develop counteracting interventions to maintain children?s health during exceptional situations like pandemics. However, worldwide data from such interventions are limited, and to our knowledge, no suitable study has been carried out during the pandemic in Austria. Objective: This study was conducted to examine a 15-week web-based intervention with email support, the EDDY (Effect of Sports and Diet Trainings to Prevent Obesity and Secondary Diseases and to Influence Young Children?s Lifestyle) program and the effect of nutritional education and physical activity on children?s BMI z-score during the COVID-19 pandemic in Vienna, Austria. Methods: The intervention consisted of 3 weekly videos?2 physical activity and 1 nutritional education video, respectively?and a biweekly email newsletter for the parents. This study was conducted in a Viennese primary school from February to June 2021 by a team of physicians, nutritionists, and sports scientists, including both professionals and students. The study population included an intervention group (who received web-based nutritional and physical activity training) and a control group (who received no intervention), comprising in total 125 children aged 8 to 11 years. Due to COVID-19 mitigation measures, the control group was a comparative group observed during the prior school year (2019-2020). Anthropometric measurements were obtained before and after the intervention in both groups. Results: Due to a high dropout rate (n=57, 45.6%) because of the mitigation measures, there were 41 children in the intervention group and 27 in the control group. At baseline, the BMI z-score was 1.0 (SD 1.1) in the intervention group and 0.6 (SD 1.2) in the control group (P=.17). After the study period, the BMI z-score decreased by 0.06 (SD 0.21) in the intervention group, whereas it increased by 0.17 (SD 0.34) in the control group (P<.001). Comparing the change in BMI z-scores within BMI categories in the intervention group and control group revealed a statistically significant difference in the normal-weight children (P=.006). Further results showed that the decrease in BMI z-score was significant in the intervention group among both boys (P=.004) and girls (P=.01). Conclusions: A web-based intervention with combined nutritional education and physical activity training might be an adequate tool to lessen the enhanced increase in body weight during a pandemic. Therefore, additional studies with greater sample sizes and different locations are needed. As the implementation of such intervention programs is essential, further studies need to be established rapidly. UR - https://pediatrics.jmir.org/2024/1/e50289 UR - http://dx.doi.org/10.2196/50289 ID - info:doi/10.2196/50289 ER - TY - JOUR AU - Weiner, S. Lauren AU - Crowley, N. Ryann AU - Sheeber, B. Lisa AU - Koegler, H. Frank AU - Davis, F. Jon AU - Wells, Megan AU - Funkhouser, J. Carter AU - Auerbach, P. Randy AU - Allen, B. Nicholas PY - 2024/9/19 TI - Engagement, Acceptability, and Effectiveness of the Self-Care and Coach-Supported Versions of the Vira Digital Behavior Change Platform Among Young Adults at Risk for Depression and Obesity: Pilot Randomized Controlled Trial JO - JMIR Ment Health SP - e51366 VL - 11 KW - depression KW - behavioral activation KW - digital health KW - mental health KW - behavior change KW - mobile sensing KW - anxiety KW - health coaching KW - mobile phone N2 - Background: Adolescence and early adulthood are pivotal stages for the onset of mental health disorders and the development of health behaviors. Digital behavioral activation interventions, with or without coaching support, hold promise for addressing risk factors for both mental and physical health problems by offering scalable approaches to expand access to evidence-based mental health support. Objective: This 2-arm pilot randomized controlled trial evaluated 2 versions of a digital behavioral health product, Vira (Ksana Health Inc), for their feasibility, acceptability, and preliminary effectiveness in improving mental health in young adults with depressive symptoms and obesity risk factors. Methods: A total of 73 participants recruited throughout the United States were randomly assigned to use Vira either as a self-guided product (Vira Self-Care) or with support from a health coach (Vira+Coaching) for 12 weeks. The Vira smartphone app used passive sensing of behavioral data related to mental health and obesity risk factors (ie, activity, sleep, mobility, and language patterns) and offered users personalized insights into patterns of behavior associated with their daily mood. Participants completed self-reported outcome measures at baseline and follow-up (12 weeks). All study procedures were completed via digital communications. Results: Both versions of Vira showed strong user engagement, acceptability, and evidence of effectiveness in improving mental health and stress. However, users receiving coaching exhibited more sustained engagement with the platform and reported greater reductions in depression (Cohen d=0.45, 95% CI 0.10-0.82) and anxiety (Cohen d=0.50, 95% CI 0.13-0.86) compared to self-care users. Both interventions also resulted in reduced stress (Vira+Coaching: Cohen d=?1.05, 95% CI ?1.57 to ?-0.50; Vira Self-Care: Cohen d=?0.78, 95% CI ?1.33 to ?0.23) and were perceived as useful and easy to use. Coached users also reported reductions in sleep-related impairment (Cohen d=?0.51, 95% CI ?1.00 to ?0.01). Moreover, participants increased their motivation for and confidence in making behavioral changes, with greater improvements in confidence among coached users. Conclusions: An app-based intervention using passive mobile sensing to track behavior and deliver personalized insights into behavior-mood associations demonstrated feasibility, acceptability, and preliminary effectiveness for reducing depressive symptoms and other mental health problems in young adults. Future directions include (1) optimizing the interventions, (2) conducting a fully powered trial that includes an active control condition, and (3) testing mediators and moderators of outcome effects. Trial Registration: ClinicalTrials.gov NCT05638516; https://clinicaltrials.gov/study/NCT05638516 UR - https://mental.jmir.org/2024/1/e51366 UR - http://dx.doi.org/10.2196/51366 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51366 ER - TY - JOUR AU - Ghabashi, Adil Mai AU - Azzeh, Sultan Firas PY - 2024/9/16 TI - Factors Influencing Malnutrition Among Older Adult Residents in the Western Region of Saudi Arabia: Sex Differential Study JO - JMIR Aging SP - e55572 VL - 7 KW - Elderly KW - Makkah KW - Malnutrition KW - Mini Nutritional Assessment Short Form KW - Risk factors N2 - Background: The global population of older adults is on the rise. As people age, their physical functions gradually decline, leading to a decrease in the overall functioning of different organ systems. Due to these changes, older individuals are at a higher risk of encountering various adverse health outcomes and complications, such as malnutrition. Objective: This study aims to investigate the prevalence of malnutrition and its associated factors among older adults dwelling in the western region of Saudi Arabia. We have analyzed these factors separately for both men and women to understand any potential sex differences. Methods: A nonrandomized cross-sectional study was conducted for older adults aged ?60 years in the western region of Saudi Arabia. Personal information was obtained through a closed questionnaire. The Mini Nutritional Assessment Short Form was used to determine the malnutrition status of older adults. Consequently, the individuals were divided into 2 groups: normal and malnourished. To assess the risk factors related to malnutrition, the odds ratio (OR) and 95% CI were determined using a binary logistic regression. Results: The prevalence of malnutrition in men and women was around 7% and 5%, respectively. Potential risk factors related to malnutrition in men were higher age (OR 1.263, 95% CI 1.086-1.468; P=.002), being widowed (OR 8.392, 95% CI 1.002-70.258; P=.049), and having dental problems (OR 9.408, 95% CI 1.863-47.514; P=.007). On the other hand, risk factors associated with malnutrition in women were lower BMI (OR 0.843, 95% CI 0.747-0.952; P=.006) and being disabled (OR 18.089, 95% CI 0.747-0.952; P=.006). Conclusions: The findings of this study provide important insights into the risk factors for malnutrition among older adults in the western region of Saudi Arabia. While the overall prevalence of malnutrition was relatively low, the analysis revealed distinct risk factors for older men and women. Interventions developed based on the identified risk factors may prove effective in addressing the issue of malnutrition within this population. UR - https://aging.jmir.org/2024/1/e55572 UR - http://dx.doi.org/10.2196/55572 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55572 ER - TY - JOUR AU - Gálvez Espinoza, Patricia AU - Rodríguez Osiac, Lorena AU - Franch Maggiolo, Carolina AU - Egaña Rojas, Daniel PY - 2024/9/13 TI - Rethinking the Social Determination of Food in Chile Through Practices and Interactions of Actors in Food Environments: Nonexperimental, Cross-Sectional Study JO - JMIR Res Protoc SP - e62765 VL - 13 KW - mixed methods KW - research design KW - food environments KW - food intake KW - obesity N2 - Background: Food environments are crucial for promoting healthy and sustainable eating and preventing obesity. However, existing food environment frameworks assume an already installed causality and do not explain how associations in food environments are established or articulated, especially from an integrative and transdisciplinary approach. This research attempts to bridge these gaps through the use of Actor-Network Theory, which traces the relationship network between human (and nonhuman) actors in order to describe how these interact and what agencies (direct or remote) are involved. Objective: This study aims to explain the practices and interactions of actors in food environments in order to approach the problem of unhealthy eating with a transdisciplinary approach. Methods: This is a nonexperimental, cross-sectional study. Due to the complexity of the study phenomena, a mixed methods approach with 4 consecutive phases will be developed in Chile. Phase 1 involves a systematic literature review of food environment evidence since 2015, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol; phase 2 involves the application of a shortened version of the Nutrition Environment Measure Scale?Perceptions adapted to Chile (NEMS-P-Ch) in 2 neighborhoods with different socioeconomic levels; in phase 3, six focus groups in each neighborhood will be conducted to address social determinants such as gender, employment status, and migration; and in phase 4, participant observation and in-depth interviews will be used to analyze the direct and empirical exploration of the actors in their daily interaction with food environments. The triangulation and complementarity of the data will allow us to create a practical model about the practices and interactions of actors in their food environments, which reflects the complexity and transdisciplinary nature of the study. Results: We have advanced in phases 1-3 of the study. In phase 1, a total of 109 manuscripts are being revised for data extraction. In phase 2, we applied the NEMS-P-Ch to 785 people, 49.4% (388/785) of whom belong to a low socioeconomic neighborhood. Participants from phase 2 are being contacted to participate in the focus groups (phase 3). By the end of July, we have conducted 6 focus groups with 5-11 participants. Conclusions: This study will provide a comprehensive understanding of how individuals interact with their food environments, offering deep insights into the factors influencing their food-related decisions. In addition, the study aims to develop a model that more accurately reflects reality by examining not only the food environments themselves but also the interactions among various stakeholders within these environments and their daily practices. The findings of this study will offer evidence-based insights to inform public policies tailored to the specific territories and communities under investigation or those with similar characteristics. International Registered Report Identifier (IRRID): DERR1-10.2196/62765 UR - https://www.researchprotocols.org/2024/1/e62765 UR - http://dx.doi.org/10.2196/62765 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62765 ER - TY - JOUR AU - Ng, Min Hwei AU - Maggo, Jasjot AU - Wall, Louisa Catherine AU - Bayer, Brigit Simone AU - McNabb, C. Warren AU - Mullaney, Adair Jane AU - Foster, Meika AU - Cabrera, L. Diana AU - Fraser, Karl AU - Cooney, Janine AU - Trower, Tania AU - Günther, S. Catrin AU - Frampton, Chris AU - Gearry, Blair Richard AU - Roy, Clemence Nicole PY - 2024/8/29 TI - Effects of Defatted Rice Bran?Fortified Bread on the Gut Microbiota Composition of Healthy Adults With Low Dietary Fiber Intake: Protocol for a Crossover Randomized Controlled Trial JO - JMIR Res Protoc SP - e59227 VL - 13 KW - dietary fiber KW - defatted rice bran KW - bread KW - healthy adults KW - gut microbiota KW - metabolites KW - gut physiome KW - randomized controlled trial KW - mobile phone N2 - Background: Inadequate dietary fiber (DF) intake is associated with several human diseases. Bread is commonly consumed, and its DF content can be increased by incorporating defatted rice bran (DRB). Objective: This first human study on DRB-fortified bread primarily aims to assess the effect of DRB-fortified bread on the relative abundance of a composite of key microbial genera and species in fecal samples. Secondary outcomes include clinical (cardiovascular risk profile), patient-reported (daily bread consumption and bowel movement, gut comfort, general well-being, and total DF intake), biological (fecal microbiota gene abundances, and fecal and plasma metabolites), and physiome (whole-gut and regional transit time and gas fermentation profiles) outcomes in healthy adults with low DF intake. Methods: This is a 2-armed, placebo-controlled, double-blinded, crossover randomized controlled trial. The study duration is 14 weeks: 2 weeks of lead-in, 4 weeks of intervention per phase, 2 weeks of washout, and 2 weeks of follow-up. Overall, 60 healthy adults with low DF intake (<18 g [female individuals] or <22 g [male individuals] per day) were recruited in Christchurch, New Zealand, between June and December 2022. Randomly assigned participants consumed 3 (female individuals) or 4 (male individuals) slices of DRB-fortified bread per day and then placebo bread, and vice versa. The DRB-fortified bread provided 8 g (female individuals) or 10.6 g (male individuals) of total DF, whereas the placebo (a matched commercial white toast bread) provided 2.7 g (female individuals) or 3.6 g (male individuals) of total DF. Before and after each intervention phase, participants provided fecal and blood samples to assess biological responses; completed a 3-day food diary to assess usual intakes and web-based questionnaires to assess gut comfort, general and mental well-being, daily bread intake, and bowel movement via an app; underwent anthropometry and blood pressure measurements; and drank blue food dye to assess whole-gut transit time. Additionally, 25% (15/60) of the participants ingested Atmo gas-sensing capsules to assess colonic gas fermentation profile and whole-gut and regional transit time. Mean differences from baseline will be compared between the DRB and placebo groups, as well as within groups (after the intervention vs baseline). For metabolome analyses, comparisons will be made within and between groups using postintervention values. Results: Preliminary analysis included 56 participants (n=33, 59% female; n=23, 41% male). Due to the large dataset, data analysis was planned to be fully completed by the last quarter of 2024, with full results expected to be published in peer-reviewed journals by the end of 2024. Conclusions: This first human study offers insights into the prospect of consuming DRB-fortified bread to effectively modulate health-promoting gut microbes, their metabolism, and DF intake in healthy adults with low DF intake. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000884707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383814 International Registered Report Identifier (IRRID): DERR1-10.2196/59227 UR - https://www.researchprotocols.org/2024/1/e59227 UR - http://dx.doi.org/10.2196/59227 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59227 ER - TY - JOUR AU - Taira, Gabriella Kimi AU - Wang, Madelyn AU - Guo, William AU - Kam, Olivia AU - Kaufmann, Tara PY - 2024/8/20 TI - Association of Cellulitis With Obesity: Systematic Review and Meta-Analysis JO - JMIR Dermatol SP - e54302 VL - 7 KW - cellulitis KW - obesity KW - overweight KW - systematic review KW - meta-analysis KW - skin infection KW - body mass index KW - BMI N2 - Background: Cellulitis is a bacterial skin infection that tends to recur. Previous studies have identified several risk factors that may contribute to its pathogenesis. Obesity is an increasingly prevalent worldwide disease that has been associated with skin and soft tissue infections. Objective: The aim of our systematic review and meta-analysis was to investigate the association of cellulitis with obesity. Methods: The Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched for the relevant studies from the inception of each respective database to March 13, 2021. Case-control, cross-sectional, or cohort studies that examined the odds or risk of increased BMI in patients with cellulitis were included. This study was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa scale (NOS) was used to evaluate the risk of bias in included studies. Results: In total, 9 case-control studies were included in our quantitative meta-analysis with a total of 68,148 study participants. A significant association was found between cellulitis and obesity (pooled odds ratio [OR] 2.67, 95% CI 1.91-3.71). No significant association was observed between cellulitis and being overweight (pooled OR 1.69, 95% CI 0.99-2.88). Patients with cellulitis were also found to have 1.63-fold increased odds of being male (pooled OR 1.63, 95% CI 1.12-2.38). Conclusions: Our findings suggest that cellulitis is significantly associated with obesity. Maintaining a healthy BMI may be indicated for patients presenting with cellulitis. UR - https://derma.jmir.org/2024/1/e54302 UR - http://dx.doi.org/10.2196/54302 UR - http://www.ncbi.nlm.nih.gov/pubmed/39163102 ID - info:doi/10.2196/54302 ER - TY - JOUR AU - Jia, Si Si AU - Luo, Xinwei AU - Gibson, Anne Alice AU - Partridge, Ruth Stephanie PY - 2024/8/13 TI - Developing the DIGIFOOD Dashboard to Monitor the Digitalization of Local Food Environments: Interdisciplinary Approach JO - JMIR Public Health Surveill SP - e59924 VL - 10 KW - online food delivery KW - food environment KW - dashboard KW - web scraping KW - big data KW - surveillance KW - monitoring KW - prevention KW - food KW - food delivery KW - development study KW - development KW - accessibility KW - Australia KW - monitoring tool KW - tool KW - tools N2 - Background: Online food delivery services (OFDS) enable individuals to conveniently access foods from any deliverable location. The increased accessibility to foods may have implications on the consumption of healthful or unhealthful foods. Concerningly, previous research suggests that OFDS offer an abundance of energy-dense and nutrient-poor foods, which are heavily promoted through deals or discounts. Objective: In this paper, we describe the development of the DIGIFOOD dashboard to monitor the digitalization of local food environments in New South Wales, Australia, resulting from the proliferation of OFDS. Methods: Together with a team of data scientists, we designed a purpose-built dashboard using Microsoft Power BI. The development process involved three main stages: (1) data acquisition of food outlets via web scraping, (2) data cleaning and processing, and (3) visualization of food outlets on the dashboard. We also describe the categorization process of food outlets to characterize the healthfulness of local, online, and hybrid food environments. These categories included takeaway franchises, independent takeaways, independent restaurants and cafes, supermarkets or groceries, bakeries, alcohol retailers, convenience stores, and sandwich or salad shops. Results: To date, the DIGIFOOD dashboard has mapped 36,967 unique local food outlets (locally accessible and scraped from Google Maps) and 16,158 unique online food outlets (accessible online and scraped from Uber Eats) across New South Wales, Australia. In 2023, the market-leading OFDS operated in 1061 unique suburbs or localities in New South Wales. The Sydney-Parramatta region, a major urban area in New South Wales accounting for 28 postcodes, recorded the highest number of online food outlets (n=4221). In contrast, the Far West and Orana region, a rural area in New South Wales with only 2 postcodes, recorded the lowest number of food outlets accessible online (n=7). Urban areas appeared to have the greatest increase in total food outlets accessible via online food delivery. In both local and online food environments, it was evident that independent restaurants and cafes comprised the largest proportion of food outlets at 47.2% (17,437/36,967) and 51.8% (8369/16,158), respectively. However, compared to local food environments, the online food environment has relatively more takeaway franchises (2734/16,158, 16.9% compared to 3273/36,967, 8.9%) and independent takeaway outlets (2416/16,158, 14.9% compared to 4026/36,967, 10.9%). Conclusions: The DIGIFOOD dashboard leverages the current rich data landscape to display and contrast the availability and healthfulness of food outlets that are locally accessible versus accessible online. The DIGIFOOD dashboard can be a useful monitoring tool for the evolving digital food environment at a regional scale and has the potential to be scaled up at a national level. Future iterations of the dashboard, including data from additional prominent OFDS, can be used by policy makers to identify high-priority areas with limited access to healthful foods both online and locally. UR - https://publichealth.jmir.org/2024/1/e59924 UR - http://dx.doi.org/10.2196/59924 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59924 ER - TY - JOUR AU - Woolhiser, Emily AU - Keime, Noah AU - Patel, Arya AU - Weber, Isaac AU - Adelman, Madeline AU - Dellavalle, P. Robert PY - 2024/8/5 TI - Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review JO - JMIR Dermatol SP - e50143 VL - 7 KW - seborrheic dermatitis KW - systematic review KW - diet KW - nutritional supplements KW - alcohol KW - BMI KW - body mass index KW - skin KW - review methods KW - review methodology KW - nutrition KW - nutritional KW - supplement KW - supplements KW - dermatology KW - dermatitis KW - nutrient KW - nutrients KW - micronutrient KW - micronutrients KW - vitamin KW - vitamins KW - mineral KW - minerals KW - obesity KW - obese KW - weight N2 - Background: Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity. Objective: This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research. Methods: A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (>14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence. Results: A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed. Conclusions: This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed. Trial Registration: PROSPERO CRD42023417768; https://tinyurl.com/bdcta893 UR - https://derma.jmir.org/2024/1/e50143 UR - http://dx.doi.org/10.2196/50143 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50143 ER - TY - JOUR AU - Kang, Bossng AU - Kim, Changsun AU - Shin, Seon-Hi AU - Shin, Hyungoo AU - Cho, Yongil PY - 2024/7/31 TI - Impact of Alcohol-Induced Facial Flushing Phenotype on Alcohol Consumption Among Korean Adults: 2-Year Cross-Sectional Study JO - JMIR Public Health Surveill SP - e49826 VL - 10 KW - facial flushing KW - alcohol consumption KW - drinking behavior KW - alcohol KW - acetaldehyde KW - aldehyde dehydrogenase 2 polymorphism KW - East Asian N2 - Background: The alcohol-induced facial flushing phenotype (flushing) is common among East Asians. Despite a small intake of alcohol, they experience heightened levels of acetaldehyde, a group-1 carcinogen, which, in turn, causes unpleasant symptoms such as redness, acting as a robust protective mechanism against consuming alcohol. However, some individuals with this genetic trait exhibit weakened alcohol restraint, which increases the risk of developing alcohol-related cancers, such as esophageal and head or neck cancer, by several times. Although this flushing phenomenon is crucial for public health, there is a paucity of studies that have comprehensively investigated the effect of flushing or its genotype on alcohol consumption in a large group of East Asians while controlling for various sociodemographic and health-related variables at a country level. Objective: This 2-year cross-sectional study aims to explore the effect of flushing on drinking behavior in Koreans and to examine whether the effect varies across sociodemographic and health-related factors. Methods: We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) for 2019 and 2020 conducted by the Korea Disease Control and Prevention Agency. Our sample comprised 10,660 Korean adults. The study investigated the association of 26 variables, including flushing, with drinking frequency and amount. The effect of flushing was examined with and without adjusting for the other 25 variables using multinomial logistic regression analysis. In addition, we tested the interaction effect with flushing and conducted a simple effect analysis. We used complex sample design elements, including strata, clusters, and weights, to obtain unbiased results for the Rao-Scott ?2 test, 2-tailed t test, and multinomial logistic regression analysis. Results: The suppressive effect of flushing was significant (P<.001) across all pronounced categories of alcohol consumption in 2019. The ranges of standardized regression slopes and odds ratios (ORs) were ?6.70????11.25 and 0.78?OR?0.50 for frequency and ?5.37????17.64 and 0.73?OR?0.36 for amount, respectively. The effect became somewhat stronger when adjusted for confounders. The effect also exhibited an overall stronger trend as the severity of alcohol consumption increased. The ? values and ORs were consistently smaller in 2020 compared to the previous year. A simple effect analysis revealed a diminished alcohol-suppressive effect of flushing on alcohol consumption for specific groups (eg, those with low levels of education, limited family support, physical labor, or health-related issues). Conclusions: Our findings suggest that flushing suppresses drinking in Koreans overall but has little or no effect in certain susceptible populations. Therefore, health authorities should conduct targeted epidemiological studies to assess drinking patterns and disease profiles, particularly regarding alcohol-related cancers, and establish effective preventive measures tailored to this population. UR - https://publichealth.jmir.org/2024/1/e49826 UR - http://dx.doi.org/10.2196/49826 UR - http://www.ncbi.nlm.nih.gov/pubmed/38796304 ID - info:doi/10.2196/49826 ER - TY - JOUR AU - Mateo-Orcajada, Adrián AU - Vaquero-Cristóbal, Raquel AU - Mota, Jorge AU - Abenza-Cano, Lucía PY - 2024/7/30 TI - Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e51206 VL - 12 KW - body composition KW - detraining KW - new technologies KW - physical education subject KW - physical fitness KW - youth N2 - Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants? PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD ?0.170; P<.001), maximal oxygen uptake (MD ?1.006; P<.001), countermovement jump test (MD ?1.337; P=.04), curl-up test (MD ?3.791; P<.001), and push-up test (MD ?1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 UR - https://mhealth.jmir.org/2024/1/e51206 UR - http://dx.doi.org/10.2196/51206 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51206 ER - TY - JOUR AU - Chun, Minki AU - Yu, Ha-Jin AU - Jung, Hyunggu PY - 2024/7/3 TI - A Deep Learning?Based Rotten Food Recognition App for Older Adults: Development and Usability Study JO - JMIR Form Res SP - e55342 VL - 8 KW - digital health KW - mobile health KW - mHealth KW - app KW - apps KW - application KW - applications KW - smartphone KW - smartphones KW - classification KW - digital sensor KW - deep learning KW - artificial intelligence KW - machine learning KW - food KW - foods KW - fruit KW - fruits KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - usability KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - aged KW - camera KW - image KW - imaging KW - photo KW - photos KW - photograph KW - photographs KW - recognition KW - picture KW - pictures KW - sensor KW - sensors KW - develop KW - development KW - design N2 - Background: Older adults are at greater risk of eating rotten fruits and of getting food poisoning because cognitive function declines as they age, making it difficult to distinguish rotten fruits. To address this problem, researchers have developed and evaluated various tools to detect rotten food items in various ways. Nevertheless, little is known about how to create an app to detect rotten food items to support older adults at a risk of health problems from eating rotten food items. Objective: This study aimed to (1) create a smartphone app that enables older adults to take a picture of food items with a camera and classifies the fruit as rotten or not rotten for older adults and (2) evaluate the usability of the app and the perceptions of older adults about the app. Methods: We developed a smartphone app that supports older adults in determining whether the 3 fruits selected for this study (apple, banana, and orange) were fresh enough to eat. We used several residual deep networks to check whether the fruit photos collected were of fresh fruit. We recruited healthy older adults aged over 65 years (n=15, 57.7%, males and n=11, 42.3%, females) as participants. We evaluated the usability of the app and the participants? perceptions about the app through surveys and interviews. We analyzed the survey responses, including an after-scenario questionnaire, as evaluation indicators of the usability of the app and collected qualitative data from the interviewees for in-depth analysis of the survey responses. Results: The participants were satisfied with using an app to determine whether a fruit is fresh by taking a picture of the fruit but are reluctant to use the paid version of the app. The survey results revealed that the participants tended to use the app efficiently to take pictures of fruits and determine their freshness. The qualitative data analysis on app usability and participants? perceptions about the app revealed that they found the app simple and easy to use, they had no difficulty taking pictures, and they found the app interface visually satisfactory. Conclusions: This study suggests the possibility of developing an app that supports older adults in identifying rotten food items effectively and efficiently. Future work to make the app distinguish the freshness of various food items other than the 3 fruits selected still remains. UR - https://formative.jmir.org/2024/1/e55342 UR - http://dx.doi.org/10.2196/55342 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55342 ER - TY - JOUR AU - Polfuss, Michele AU - Smith, Kathryn AU - Hopson, Betsy AU - Moosreiner, Andrea AU - Huang, Chiang-Ching AU - Ravelli, N. Michele AU - Ding, Dan AU - Huang, Zijian AU - Rocque, G. Brandon AU - White-Traut, Rosemary AU - Van Speybroeck, Alexander AU - Sawin, J. Kathleen PY - 2024/7/2 TI - Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study JO - JMIR Res Protoc SP - e52779 VL - 13 KW - obesity KW - overweight KW - body composition KW - energy expenditure KW - doubly labeled water KW - spina bifida KW - children KW - adolescents KW - wearable device N2 - Background: Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations. Objective: The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample. Methods: This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis. Results: The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1%; male participants: n=67, 46.9%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings. Conclusions: This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths? weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems. International Registered Report Identifier (IRRID): DERR1-10.2196/52779 UR - https://www.researchprotocols.org/2024/1/e52779 UR - http://dx.doi.org/10.2196/52779 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52779 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - Lee, HyunHae AU - Kim, Ji-Su AU - Shin, Hyerine PY - 2024/6/28 TI - Predicting the Transition to Metabolically Unhealthy Obesity Among Young Adults With Metabolically Healthy Obesity in South Korea: Nationwide Population-Based Study JO - JMIR Public Health Surveill SP - e52103 VL - 10 KW - metabolically healthy obesity KW - metabolic syndrome KW - metabolically unhealthy obesity KW - nomogram KW - obesity KW - young adult KW - male KW - noncommunicable disease KW - South Korea KW - population-based study KW - intervention N2 - Background: Globally, over 39% of individuals are obese. Metabolic syndrome, usually accompanied by obesity, is regarded as a major contributor to noncommunicable diseases. Given this relationship, the concepts of metabolically healthy and unhealthy obesity, considering metabolic status, have been evolving. Attention is being directed to metabolically healthy people with obesity who have relatively low transition rates to noncommunicable diseases. As obesity rates continue to rise and unhealthy behaviors prevail among young adults, there is a growing need for obesity management that considers these metabolic statuses. A nomogram can be used as an effective tool to predict the risk of transitioning to metabolically unhealthy obesity from a metabolically healthy status. Objective: The study aimed to identify demographic factors, health behaviors, and 5 metabolic statuses related to the transition from metabolically healthy obesity to unhealthy obesity among people aged between 20 and 44 years and to develop a screening tool to predict this transition. Methods: This secondary analysis study used national health data from the National Health Insurance System in South Korea. We analyzed the customized data using SAS (SAS Institute Inc) and conducted logistic regression to identify factors related to the transition from metabolically healthy to unhealthy obesity. A nomogram was developed to predict the transition using the identified factors. Results: Among 3,351,989 people, there was a significant association between the transition from metabolically healthy to unhealthy obesity and general characteristics, health behaviors, and metabolic components. Male participants showed a 1.30 higher odds ratio for transitioning to metabolically unhealthy obesity than female participants, and people in the lowest economic status were also at risk for the transition (odds ratio 1.08, 95% CI 1.05-1.1). Smoking status, consuming >30 g of alcohol, and insufficient regular exercise were negatively associated with the transition. Each relevant variable was assigned a point value. When the nomogram total points reached 295, the shift from metabolically healthy to unhealthy obesity had a prediction rate of >50%. Conclusions: This study identified key factors for young adults transitioning from healthy to unhealthy obesity, creating a predictive nomogram. This nomogram, including triglycerides, waist circumference, high-density lipoprotein-cholesterol, blood pressure, and fasting glucose, allows easy assessment of obesity risk even for the general population. This tool simplifies predictions amid rising obesity rates and interventions. UR - https://publichealth.jmir.org/2024/1/e52103 UR - http://dx.doi.org/10.2196/52103 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52103 ER - TY - JOUR AU - Lin, Shu-Cheng AU - Wang, Chien-Yen AU - Hou, Tien-Hung AU - Chen, Hong-Ching AU - Wang, Chia-Chi PY - 2024/6/25 TI - Impact of Fruit and Vegetable Enzyme Supplementation on Aerobic Performance and Lactate Response in Older Adults Following High-Intensity Interval Exercise Through Exergaming: Randomized Experimental Matched-Pair Study JO - JMIR Serious Games SP - e52231 VL - 12 KW - Ring Fit Adventure KW - training load KW - older adult training KW - training impulse KW - food supplement KW - older adults KW - exergames KW - exergame KW - Taiwan KW - female KW - fruits KW - vegetables KW - blood lactate KW - exercise KW - feasibility KW - aerobic KW - enzymes KW - enzyme KW - female older adults KW - fitness KW - food intake KW - diet KW - exergaming KW - enzyme supplements KW - older adults training KW - female older adult KW - older adult N2 - Background: Exercise offers substantial health benefits but can induce oxidative stress and inflammation, especially in high-intensity formats such as high-intensity interval exercise (HIIE). Exergaming has become an effective, enjoyable fitness tool for all ages, particularly older adults. Enzyme supplements may enhance exercise performance by improving lactate metabolism and reducing oxidative stress. Objective: This study investigates the efficacy of fruit and vegetable enzyme supplementation in modulating fatigue and enhancing aerobic capacity in older adults following HIIE through exergaming. Methods: The study recruited 16 older adult female participants and allocated them into 2 distinct groups (enzyme and placebo) based on their pretest lactate levels. This division used pairwise grouping to guarantee comparability between the groups, ensuring the integrity of the results. They engaged in HIIE using Nintendo Switch Ring Fit Adventure, performing 8 sets of 20 seconds of maximum effort exercise interspersed with 30 seconds of rest, totaling 370 seconds of exercise. Key metrics assessed included blood lactate levels, heart rate, rating of perceived exertion, and training impulse. Participants in the enzyme group were administered a fruit and vegetable enzyme supplement at a dosage of 30 mL twice daily over a period of 14 days. Results: The enzyme group showed significantly lower blood lactate levels compared to the placebo group, notably after the fourth (mean 4.29, SD 0.67 vs mean 6.34, SD 1.17 mmol/L; P=.001) and eighth (mean 5.84, SD 0.63 vs mean 8.20, SD 1.15 mmol/L; P<.001) exercise sessions. This trend continued at 5 minutes (mean 6.85, SD 0.82 vs mean 8.60, SD 1.13 mmol/L; P=.003) and 10 minutes (mean 5.91, SD 1.16 vs mean 8.21, SD 1.27 mmol/L; P=.002) after exercise. Although both groups exceeded 85% of their estimated maximum heart rate during the exercise, enzyme supplementation did not markedly affect the perceived intensity or effort. Conclusions: The study indicates that fruit and vegetable enzyme supplementation can significantly reduce blood lactate levels in older adults following HIIE through exergaming. This suggests a potential role for these enzymes in modulating lactate production or clearance during and after high-intensity exercise. These findings have implications for developing targeted interventions to enhance exercise tolerance and recovery in older adults. Trial Registration: ClinicalTrials.gov NCT06466408; https://clinicaltrials.gov/study/NCT06466408 UR - https://games.jmir.org/2024/1/e52231 UR - http://dx.doi.org/10.2196/52231 ID - info:doi/10.2196/52231 ER - TY - JOUR AU - Mills, Marie Christine AU - Boyar, Liza AU - O?Flaherty, A. Jessica AU - Keller, H. Heather PY - 2024/6/25 TI - Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e56714 VL - 13 KW - community KW - malnutrition risk KW - nutrition risk KW - older adults KW - social factors KW - geriatric KW - geriatrics KW - malnutrition KW - community-dwelling KW - older adult KW - elderly KW - HIC KW - high-income countries KW - diet KW - dietary intake KW - nutritional status KW - Canada KW - nutritional risk KW - social KW - intervention KW - public health KW - community-based intervention KW - health promotion N2 - Background: In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors? knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. Objective: The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs. Methods: This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk. Results: The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. Conclusions: Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. International Registered Report Identifier (IRRID): DERR1-10.2196/56714 UR - https://www.researchprotocols.org/2024/1/e56714 UR - http://dx.doi.org/10.2196/56714 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696645 ID - info:doi/10.2196/56714 ER - TY - JOUR AU - Terada, Marina AU - Okuhara, Tsuyoshi AU - Yokota, Rie AU - Kiuchi, Takahiro AU - Murakami, Kentaro PY - 2024/6/20 TI - Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis JO - J Med Internet Res SP - e49077 VL - 26 KW - Twitter KW - food KW - nutrition KW - misinformation KW - salt KW - content analysis KW - hypertension KW - blood pressure KW - sodium KW - salt reduction N2 - Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. Results: Of the 2347 tweets, 80% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1% (n=1301), followed by potassium at 8.4% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75% (n=21) of tweets from ?doctors? mentioned salt reduction is effective for hypertension control, while 31.1% (n=74) of tweets from ?health, losing weight, and beauty-related users,? 25.9% (n=429) of tweets from ?general public,? and 23.5% (n=4) tweets from ?dietitian or registered dietitian? denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic. UR - https://www.jmir.org/2024/1/e49077 UR - http://dx.doi.org/10.2196/49077 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49077 ER - TY - JOUR AU - Pare, M. Shannon AU - Gunn, Elizabeth AU - Morrison, M. Katherine AU - Miller, L. Alison AU - Duncan, M. Alison AU - Buchholz, C. Andrea AU - Ma, L. David W. AU - Tremblay, F. Paul AU - Vallis, Ann Lori AU - Mercer, J. Nicola AU - Haines, Jess PY - 2024/6/20 TI - Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study JO - JMIR Res Protoc SP - e48549 VL - 13 KW - stress KW - child, preschool KW - adiposity KW - household chaos KW - cortisol KW - COVID-19 KW - behavioral mechanisms KW - caregiver-child relationship quality N2 - Background: Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. Objective: The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. Methods: The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child?s height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child?s physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child?s mental health, as well as a 1-day dietary assessment for their child. Results: Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study?s sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children?s mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ?CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. Conclusions: Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. Trial Registration: ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711 International Registered Report Identifier (IRRID): DERR1-10.2196/48549 UR - https://www.researchprotocols.org/2024/1/e48549 UR - http://dx.doi.org/10.2196/48549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900565 ID - info:doi/10.2196/48549 ER - TY - JOUR AU - Raber, Margaret AU - Allen, Haley AU - Huang, Sophia AU - Vazquez, Maria AU - Warner, Echo AU - Thompson, Debbe PY - 2024/6/19 TI - Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis JO - JMIR Form Res SP - e51094 VL - 8 KW - misinformation KW - social media KW - Mediterranean Diet KW - content analysis KW - health communication KW - communication KW - TikTok KW - diet KW - cardiometabolic disease KW - cardiometabolic KW - consumer KW - eating KW - quality KW - mHealth KW - mobile health KW - digital health KW - promotion research KW - nutrition therapy KW - healthy diet N2 - Background: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. Objective: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. Methods: The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. Results: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals. Conclusions: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures. UR - https://formative.jmir.org/2024/1/e51094 UR - http://dx.doi.org/10.2196/51094 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51094 ER - TY - JOUR AU - Abdollahi Diba, Mitra AU - Sari Sarraf, Vahid AU - Amirsasan, Ramin AU - Dabbagh Nikoukheslat, Saeid PY - 2024/6/13 TI - Effect of a 12-Week High-Calorie-Expenditure Multimodal Exercise Program on Health Indices in Women With Overweight: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e51599 VL - 13 KW - high-calorie expenditure KW - multimodal exercise KW - International Physical Activity Questionnaire KW - IPAQ KW - body composition KW - metabolic health N2 - Background: High-calorie-expenditure training is common among endurance athletes and is an effective strategy for weight loss. Although many training protocols include walking, running, cycling, and swimming according to a target heart rate, there is limited research on high-calorie-expenditure interventions with multimodal training programs using quantitative methods. Objective: The aims of this research protocol are to (1) develop a high-calorie-expenditure training program to cover target calorie expenditure according to the trainability of women classified as overweight (according to a BMI of 25-29.9 kg/m2); (2) determine the effect of high-calorie-expenditure workouts on conditioning, glycemic variables, and body composition; and (3) evaluate the implementation of the intervention and results in comparison with outcomes obtained under a standard-calorie-expenditure training program. Methods: This is a randomized controlled trial with a pretest-posttest design. Participants include 33 women with a BMI in the overweight range (25-29.9) allocated to three groups: two intervention groups and one control group. The intervention will be conducted for 12 weeks. Participants in the first group will be assigned an exercise program with high energy expenditure of approximately 3000-3500 kilocalories/week in the form of 5 sessions per week with an intensity of 50%-75% maximum oxygen rate (VO2 max) and 60%-80% target heart rate. The second group will be assigned an exercise program with a standard energy expenditure of approximately 1200-1500 kilocalories/week with 3 sessions per week at an intensity of 60%-75% VO2 max, according to The American College of Sports Medicine guideline. The effects of the multimodal training program with daily tasks will be compared to those of the standard-calorie-expenditure and control (no exercise) conditions with respect to changes in glycemic indices and body composition. Daily calories will be calculated through the International Physical Activity Questionnaire and using Nutrition 4 software. Results: Preliminary results show significant weight loss in both the high- and standard-calorie-expenditure groups (P=.003). Significant improvements were also found in muscle percentage (P=.05) and BMI (P=.05) for the high-calorie-expenditure group. Analyses are ongoing for glycemic indices, inflammation factors, and blood parameters. Conclusions: High-calorie-expenditure training can cause further weight loss than standard exercise, which can eventually lead to greater fat mass reduction and improvement in glycemic indices. These results demonstrate that, in some cases, it may be necessary to increase the activity of women and use multimodal exercise programs with increased volume and intensity to increase the expenditure of exercise and daily activity. We found a net effect of exercise and daily activity at the individual level, whereas the daily lifestyle and physical behaviors of the participants remained constant. Trial Registration: Iranian Registry of Clinical Trials IRCT20220202053916N1; https://tinyurl.com/c8jxfw36 International Registered Report Identifier (IRRID): DERR1-10.2196/51599 UR - https://www.researchprotocols.org/2024/1/e51599 UR - http://dx.doi.org/10.2196/51599 UR - http://www.ncbi.nlm.nih.gov/pubmed/38870518 ID - info:doi/10.2196/51599 ER - TY - JOUR AU - Li, Hei Catherine Yan AU - Platkin, Charles AU - Chin, Jonathan AU - Khan, Asia AU - Bennett, Jaleel AU - Speck, Anna AU - Nielsen, Annette AU - Leung, May May PY - 2024/6/13 TI - Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study JO - JMIR Form Res SP - e50557 VL - 8 KW - SNAP KW - SNAP eligibility screening KW - food insecurity KW - college students KW - web-based tool KW - think-aloud KW - system usability KW - user experience KW - student KW - college KW - chronic health KW - stress KW - anxiety KW - barrier KW - technology KW - tool KW - Supplemental Nutrition Assistance Program KW - usability N2 - Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. UR - https://formative.jmir.org/2024/1/e50557 UR - http://dx.doi.org/10.2196/50557 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869926 ID - info:doi/10.2196/50557 ER - TY - JOUR AU - Jerome, J. Gerald AU - Appel, J. Lawrence AU - Bunyard, Linda AU - Dalcin, T. Arlene AU - Durkin, Nowella AU - Charleston, B. Jeanne AU - Kanarek, F. Norma AU - Carducci, A. Michael AU - Wang, Nae-Yuh AU - Yeh, Hsin-Chieh PY - 2024/6/12 TI - Behavioral Weight Loss Programs for Cancer Survivors Throughout Maryland: Protocol for a Pragmatic Trial and Participant Characteristics JO - JMIR Res Protoc SP - e54126 VL - 13 KW - cancer KW - obesity KW - weight loss KW - pragmatic trial KW - oncology KW - weight KW - overweight KW - obese KW - USA KW - United States KW - survivor KW - survivors KW - remote KW - self-directed KW - self-guided KW - coach KW - coaching KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - EHR KW - health record KW - health records KW - mobile phone N2 - Background: Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland. Objective: The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants. Methods: Participants were aged ?18 years, residing in Maryland, with a BMI ?25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program. Results: Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor?s degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024. Conclusions: Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs. Trial Registration: ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309 International Registered Report Identifier (IRRID): DERR1-10.2196/54126 UR - https://www.researchprotocols.org/2024/1/e54126 UR - http://dx.doi.org/10.2196/54126 UR - http://www.ncbi.nlm.nih.gov/pubmed/38865181 ID - info:doi/10.2196/54126 ER - TY - JOUR AU - Lehmann, Marco AU - Jones, Lucy AU - Schirmann, Felix PY - 2024/6/7 TI - App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data JO - J Med Internet Res SP - e45469 VL - 26 KW - obesity KW - weight loss KW - blended-care KW - digital health KW - real-world data KW - app engagement KW - mHealth KW - mobile health KW - technology engagement KW - weight management KW - mobile phone N2 - Background: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. Objective: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. Methods: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. Results: For the entire sample (N=19,211), mean weight loss was ?3.24% (SD 4.58%) at 3 months and ?5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients? messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). Conclusions: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design. UR - https://www.jmir.org/2024/1/e45469 UR - http://dx.doi.org/10.2196/45469 UR - http://www.ncbi.nlm.nih.gov/pubmed/38848556 ID - info:doi/10.2196/45469 ER - TY - JOUR AU - Craig, V. Tabitha AU - Rhodes, E. Ryan AU - Sui, Wuyou PY - 2024/6/4 TI - Examining and Comparing the Energy Expenditure of Two Modes of a Virtual Reality Fitness Game (Supernatural): Indirect Calorimetry Study JO - JMIR Serious Games SP - e53999 VL - 12 KW - energy expenditure KW - exergaming KW - indirect calorimetry KW - virtual reality KW - VR KW - VR fitness KW - VR gaming N2 - Background: The effectiveness of virtual reality (VR) fitness games as a form of moderate to vigorous physical activity has yet to be thoroughly quantified through gold standard energy expenditure measures. Objective: The purpose of this study was to examine the energy expenditure of 2 medium-intensity modes (?Flow and ?Boxing?) of a VR fitness game, Supernatural, using indirect calorimetry. Methods: Indirect calorimetry was used to examine relative and objective maximal oxygen consumption (VO2 max), metabolic equivalents of task (METs), and calories burned during medium-intensity bouts of both Flow and Boxing gameplay modes in young (mean age 25.42, SD 3.25 years), active individuals (n=12 female and n=11 male). METs and calories were also compared using a triaxial waist-worn accelerometer, an Apple smartwatch, and a VR headset. Mood states were assessed pre- and postbout using the shortened Profile of Mood States Questionnaire. Paired 2-tailed t tests were used to examine differences in game modes, between sexes, and pre-post exercise sessions. Results: Objective and relative VO2 max averaged 1.93 (SD 0.44) L/min and 27.61 (SD 5.60) mL/kg/min, respectively, between modes. Flow (mean 8.2, SD 1.54 METs) and Boxing (mean 7.6, SD 1.66 METs) are both classified as high energy expenditure, vigorous activities. Calorie expenditure data of the accelerometer and VR headset differed significantly from the metabolic cart. Mood changes pre- to post exercise were consistent with expected values for moderate- to vigorous-intensity physical activity, with participants reporting that they felt more ?active,? ?full of pep,? ?vigorous,? and ?lively? (P<.05) following bouts. Male individuals reported higher objective oxygen consumption (VO2) for both Flow and Boxing modes; no other sex-specific differences were observed. Conclusions: Both Flow and Boxing gameplay modes of Supernatural classify as vigorous physical activity and demonstrate the potential to promote mental and physical health benefits. Supernatural may be an effective exercise modality in a VO2 training program. UR - https://games.jmir.org/2024/1/e53999 UR - http://dx.doi.org/10.2196/53999 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833285 ID - info:doi/10.2196/53999 ER - TY - JOUR AU - Cantarutti, Anna AU - Rescigno, Paola AU - Da Borso, Claudia AU - Gutierrez de Rubalcava Doblas, Joaquin AU - Bressan, Silvia AU - Barbieri, Elisa AU - Giaquinto, Carlo AU - Canova, Cristina PY - 2024/5/31 TI - Association Between Early-Life Exposure to Antibiotics and Development of Child Obesity: Population-Based Study in Italy JO - JMIR Public Health Surveill SP - e51734 VL - 10 KW - childhood obesity KW - BMI z score KW - pediatric population-based KW - antibiotics KW - real-world data KW - association KW - exposure KW - child obesity KW - obesity KW - population-based KW - gut microbiome KW - early life KW - pediatric KW - prescription N2 - Background: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity. Objective: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life. Methods: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ?3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ?5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. UR - https://publichealth.jmir.org/2024/1/e51734 UR - http://dx.doi.org/10.2196/51734 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820573 ID - info:doi/10.2196/51734 ER - TY - JOUR AU - Xu, Zidu AU - Gu, Yaowen AU - Xu, Xiaowei AU - Topaz, Maxim AU - Guo, Zhen AU - Kang, Hongyu AU - Sun, Lianglong AU - Li, Jiao PY - 2024/5/30 TI - Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study JO - JMIR Form Res SP - e52170 VL - 8 KW - knowledge graph KW - personalized food recommendation KW - geriatric nutrition KW - community KW - ubiquitous computing N2 - Background: China?s older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph?based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes. Objective: This study aims to develop a knowledge graph?based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing. Methods: We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo?s effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis. Results: Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo?s meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults? own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo?s ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual?s health profile and dietary requirements. Conclusions: ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo?s performance in real-world settings, emphasizing the robust management of complex health data. The system?s scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults. UR - https://formative.jmir.org/2024/1/e52170 UR - http://dx.doi.org/10.2196/52170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38814702 ID - info:doi/10.2196/52170 ER - TY - JOUR AU - Jain, Lovely AU - Pradhan, Sreya AU - Aggarwal, Arun AU - Padhi, Kumar Bijaya AU - Itumalla, Ramaiah AU - Khatib, Nazli Mahalaqua AU - Gaidhane, Shilpa AU - Zahiruddin, Syed Quazi AU - Santos, Guimarães Celso Augusto AU - AL-Mugheed, Khalid AU - Alrahbeni, Tahani AU - Kukreti, Neelima AU - Satapathy, Prakasini AU - Rustagi, Sarvesh AU - Heidler, Petra AU - Marzo, Rillera Roy PY - 2024/5/24 TI - Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study JO - JMIR Public Health Surveill SP - e41567 VL - 10 KW - undernutrition KW - malnutrition KW - stunting KW - wasting KW - underweight KW - sanitation KW - WaSH KW - LISA KW - NFHS KW - DHS KW - spatial epidemiology KW - epidemiology KW - children KW - child KW - India KW - intervention N2 - Background: Undernutrition among children younger than 5 years is a subtle indicator of a country?s health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. UR - https://publichealth.jmir.org/2024/1/e41567 UR - http://dx.doi.org/10.2196/41567 UR - http://www.ncbi.nlm.nih.gov/pubmed/38787607 ID - info:doi/10.2196/41567 ER - TY - JOUR AU - Matthes, Jörg AU - Binder, Alice AU - Naderer, Brigitte AU - Forrai, Michaela AU - Spielvogel, Ines AU - Knupfer, Helena AU - Saumer, Melanie PY - 2024/5/22 TI - Effects of Food Depictions in Entertainment Media on Children?s Unhealthy Food Preferences: Content Analysis Linked With Panel Data JO - JMIR Pediatr Parent SP - e51429 VL - 7 KW - children KW - health KW - unhealthy food preferences KW - food depictions KW - centrality KW - coviewing KW - longitudinal linkage study KW - child KW - food KW - eating KW - diet KW - dietary KW - preference KW - preferences KW - nutrition KW - nutritional KW - media KW - entertainment KW - panel KW - foods KW - pediatric KW - pediatrics KW - food preference KW - food preferences N2 - Background: Entertainment media content is often mentioned as one of the roots of children?s unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children?s media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children?s unhealthy and healthy food consumption behaviors as outcomes. Objective: The aim is to connect content analytical data based on children?s actual media diet with panel data in order to explain children?s food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables. Methods: We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months. Results: There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=?0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=?0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=?0.001; P=.70) food consumption. Conclusions: We conclude that simply presenting more healthy foods is not sufficient to combat children?s unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children?s media. UR - https://pediatrics.jmir.org/2024/1/e51429 UR - http://dx.doi.org/10.2196/51429 ID - info:doi/10.2196/51429 ER - TY - JOUR AU - Kepper, Maura AU - Walsh-Bailey, Callie AU - Miller, M. Zoe AU - Zhao, Min AU - Zucker, Kianna AU - Gacad, Angeline AU - Herrick, Cynthia AU - White, H. Neil AU - Brownson, C. Ross AU - Foraker, E. Randi PY - 2024/5/17 TI - The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study JO - JMIR Form Res SP - e55731 VL - 8 KW - digital health KW - obesity KW - clinical care KW - adolescents KW - physical activity KW - diet KW - clinical trial N2 - Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children?s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. Trial Registration: ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193 UR - https://formative.jmir.org/2024/1/e55731 UR - http://dx.doi.org/10.2196/55731 UR - http://www.ncbi.nlm.nih.gov/pubmed/38758581 ID - info:doi/10.2196/55731 ER - TY - JOUR AU - Oshman, Lauren AU - Waselewski, Marika AU - Hisamatsu, Rina AU - Kim, Noa AU - Young, Larrea AU - Hafez Griauzde, Dina AU - Chang, Tammy PY - 2024/5/15 TI - Grocery Delivery to Support Individuals With Type 2 Diabetes: Protocol for a Pilot Quality Improvement Program JO - JMIR Res Protoc SP - e54043 VL - 13 KW - T2D KW - type 2 diabetes KW - food insecurity KW - low carbohydrate KW - quality improvement KW - healthy eating KW - grocery KW - delivery program KW - diabetes KW - T2DM KW - type 2 diabetes mellitus KW - low-income KW - US KW - United States KW - adults KW - adult KW - low diet quality KW - carbohydrate KW - carbohydrates KW - glycemic control KW - nutrition education N2 - Background: People with low income are disproportionately affected by type 2 diabetes (T2D), and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low-carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low-carbohydrate eating for people with T2D, although food-as-medicine interventions paired with nutrition education offer a promising solution. Objective: This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity. Methods: This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A1c, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up. Results: This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program. Conclusions: This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D. International Registered Report Identifier (IRRID): DERR1-10.2196/54043 UR - https://www.researchprotocols.org/2024/1/e54043 UR - http://dx.doi.org/10.2196/54043 UR - http://www.ncbi.nlm.nih.gov/pubmed/38748461 ID - info:doi/10.2196/54043 ER - TY - JOUR AU - Bould, Helen AU - Kennedy, Mari-Rose AU - Penton-Voak, Ian AU - Thomas, May Lisa AU - Bird, Jon AU - Biddle, Lucy PY - 2024/5/14 TI - Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them JO - JMIR XR Spatial Comput SP - e47382 VL - 1 KW - eating disorders KW - virtual reality KW - anorexia nervosa KW - bulimia nervosa KW - EDNOS KW - treatment KW - immersive KW - clinicians KW - qualitative data KW - psychoeducation KW - therapeutic KW - limitations N2 - Background: Immersive virtual reality (VR) interventions are being developed and trialed for use in the treatment of eating disorders. However, little work has explored the opinions of people with eating disorders, or the clinicians who treat them, on the possible use of VR in this context. Objective: This study aims to use qualitative methodology to explore the views of people with eating disorders, and clinicians who treat them, on the possible use of VR in the treatment of eating disorders. Methods: We conducted a series of focus groups and interviews with people with lived experience of eating disorders and clinicians on their views about VR and how it could potentially be used in the treatment of eating disorders. People with lived experience of eating disorders were recruited between October and December 2020, with focus groups held online between November 2020 and February 2021; clinicians were recruited in September 2021 and interviewed between September and October 2021. We took a thematic approach to analyzing the resulting qualitative data. Results: We conducted 3 focus groups with 10 individuals with a current or previous eating disorder, 2 focus groups with 4 participants, and 1 with 2 participants. We held individual interviews with 4 clinicians experienced in treating people with eating disorders. Clinicians were all interviewed one-to-one because of difficulties in scheduling mutually convenient groups. We describe themes around representing the body in VR, potential therapeutic uses for VR, the strengths and limitations of VR in this context, and the practicalities of delivering VR therapy. Suggested therapeutic uses were to practice challenging situations around food-related and weight/appearance-related scenarios and interactions, to retrain attention, the representation of the body, to represent the eating disorder, for psychoeducation, and to enable therapeutic conversations with oneself. There was a substantial agreement between the groups on these themes. Conclusions: People with lived experience of eating disorders and clinicians with experience in treating eating disorders generated many ideas as to how VR could be used as a part of eating disorders treatment. They were also aware of potential limitations and expressed the need for caution around how bodies are represented in a VR setting. UR - https://xr.jmir.org/2024/1/e47382 UR - http://dx.doi.org/10.2196/47382 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47382 ER - TY - JOUR AU - Morales-Cahuancama, Bladimir AU - Verdezoto, Nervo AU - Gonzales-Achuy, Elena AU - Quispe-Gala, Cinthia AU - Bautista-Olortegui, William AU - Hinojosa-Mamani, Paul AU - Aparco, Pablo Juan PY - 2024/5/14 TI - Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers? Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study JO - JMIR Form Res SP - e49168 VL - 8 KW - child KW - children KW - schoolchildren KW - youth KW - student KW - students KW - adolescent KW - formative research KW - digital media KW - digital games KW - serious game KW - serious games KW - nutrition KW - obesity KW - obese KW - overweight KW - mHealth KW - caregivers? perspectives KW - perspective KW - perspectives KW - diet KW - healthy eating N2 - Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren?s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren?s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren?s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children?s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers? perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren?s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. UR - https://formative.jmir.org/2024/1/e49168 UR - http://dx.doi.org/10.2196/49168 UR - http://www.ncbi.nlm.nih.gov/pubmed/38743472 ID - info:doi/10.2196/49168 ER - TY - JOUR AU - Almasri, Abdullah AU - El-Kour, Y. Tatyana AU - Silva, Liliana AU - Abdulfattah, Yousef PY - 2024/5/10 TI - Evaluating the Energy Efficiency of Popular US Smartphone Health Care Apps: Comparative Analysis Study Toward Sustainable Health and Nutrition Apps Practices JO - JMIR Hum Factors SP - e58311 VL - 11 KW - mobile health KW - energy consumption in health care smartphone apps KW - dietary tracking apps KW - optimization and sustainability in mobile health KW - user engagement and experience KW - Android apps performance KW - digital health technologies KW - app KW - apps KW - applications KW - digital health KW - energy KW - consumption KW - sustainable KW - sustainability KW - environment KW - environmental KW - use KW - smartphone KW - smartphones KW - electricity KW - electrical KW - mobile phone N2 - Background: The emergence of smartphones has sparked a transformation across multiple fields, with health care being one of the most notable due to the advent of mobile health (mHealth) apps. As mHealth apps have gained popularity, there is a need to understand their energy consumption patterns as an integral part of the evolving landscape of health care technologies. Objective: This study aims to identify the key contributors to elevated energy consumption in mHealth apps and suggest methods for their optimization, addressing a significant void in our comprehension of the energy dynamics at play within mHealth apps. Methods: Through quantitative comparative analysis of 10 prominent mHealth apps available on Android platforms within the United States, this study examined factors contributing to high energy consumption. The analysis included descriptive statistics, comparative analysis using ANOVA, and regression analysis to examine how certain factors impact energy use and consumption. Results: Observed energy use variances in mHealth apps stemmed from user interactions, features, and underlying technology. Descriptive analysis revealed variability in app energy consumption (150-310 milliwatt-hours), highlighting the influence of user interaction and app complexity. ANOVA verified these findings, indicating the critical role of engagement and functionality. Regression modeling (energy consumption = ?? + ?? × notification frequency + ?? × GPS use + ?? × app complexity + ?), with statistically significant P values (notification frequency with a P value of .01, GPS use with a P value of .05, and app complexity with a P value of .03), further quantified these bases? effects on energy use. Conclusions: The observed differences in the energy consumption of dietary apps reaffirm the need for a multidisciplinary approach to bring together app developers, end users, and health care experts to foster improved energy conservation practice while achieving a balance between sustainable practice and user experience. More research is needed to better understand how to scale-up consumer engagement to achieve sustainable development goal 12 on responsible consumption and production. UR - https://humanfactors.jmir.org/2024/1/e58311 UR - http://dx.doi.org/10.2196/58311 UR - http://www.ncbi.nlm.nih.gov/pubmed/38729624 ID - info:doi/10.2196/58311 ER - TY - JOUR AU - Kikkenborg, Julie AU - Magelund, Emma AU - Riise, Silke Maria AU - Kayser, Lars AU - Terp, Rikke PY - 2024/5/8 TI - Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study JO - JMIR Hum Factors SP - e52575 VL - 11 KW - eHealth KW - self-management KW - fall prevention KW - older adults KW - physical activity KW - nutritional intake KW - Readiness and Enablement Index for Health Technology KW - READHY KW - social support KW - support KW - management KW - fall KW - nutrition KW - diet KW - qualitative study KW - malnutrition KW - physical inactivity KW - injury KW - injuries KW - food KW - food intake KW - nutritional needs KW - outpatient clinic KW - social network KW - mobile phone N2 - Background: More than one-third of older adults (aged ?65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults? self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults? needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. Objective: This qualitative study aims to explore older adults? use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Methods: Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. Results: The qualitative data showed that the informants? social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Conclusions: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals. UR - https://humanfactors.jmir.org/2024/1/e52575 UR - http://dx.doi.org/10.2196/52575 UR - http://www.ncbi.nlm.nih.gov/pubmed/38717810 ID - info:doi/10.2196/52575 ER - TY - JOUR AU - Chew, Jocelyn Han Shi AU - Chew, WS Nicholas AU - Loong, Ern Shaun Seh AU - Lim, Lin Su AU - Tam, Wilson Wai San AU - Chin, Han Yip AU - Chao, M. Ariana AU - Dimitriadis, K. Georgios AU - Gao, Yujia AU - So, Yan Jimmy Bok AU - Shabbir, Asim AU - Ngiam, Yuan Kee PY - 2024/5/7 TI - Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation JO - J Med Internet Res SP - e46036 VL - 26 KW - artificial intelligence KW - chatbot KW - chatbots KW - weight KW - overweight KW - eating KW - food KW - weight loss KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - self-regulation KW - self-monitoring KW - anxiety KW - depression KW - consideration of future consequences KW - mental health KW - conversational agent KW - conversational agents KW - eating behavior KW - healthy eating KW - food consumption KW - obese KW - obesity KW - diet KW - dietary N2 - Background: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one?s self-regulation over momentary eating impulses. Objective: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence?assisted weight management app in improving eating behaviors in a Southeast Asian cohort. Methods: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. Results: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean ?0.32, SD 1.16; P<.001), snacking habits (mean ?0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean ?0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). Conclusions: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803 UR - https://www.jmir.org/2024/1/e46036 UR - http://dx.doi.org/10.2196/46036 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713909 ID - info:doi/10.2196/46036 ER - TY - JOUR AU - Chong, Mun Kar AU - Chia, Airu AU - Shah Budin, Syahirah Nur AU - Poh, Koon Bee AU - Jamil, Aini Nor AU - Koh, Denise AU - Chong, Foong-Fong Mary AU - Wong, Eiin Jyh PY - 2024/5/7 TI - Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children?s Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study JO - JMIR Pediatr Parent SP - e53461 VL - 7 KW - children KW - dietary intake KW - time-use diary KW - food photography KW - accuracy KW - mobile phone N2 - Background: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. Objective: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children?s meals taken by their parents as an objective reference. Methods: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children?s reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Results: Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories ?rice and porridge?; ?breads, spreads, and cereals?; and ?noodles, pasta, and potatoes? were reported most accurately (total match rates: 68%-76%). ?Snack and dessert? items were omitted most often (omission rate: 54%). Furthermore, side dishes from ?vegetables and mushrooms,? ?eggs and tofu,? ?meat and fish,? and ?curry? food groups were often omitted (omission rates: 42%-46%). Items from ?milk, cheese, and yogurt?; ?snacks and desserts?; and ?drinks? food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively). Conclusions: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children. UR - https://pediatrics.jmir.org/2024/1/e53461 UR - http://dx.doi.org/10.2196/53461 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713499 ID - info:doi/10.2196/53461 ER - TY - JOUR AU - French, Chloe AU - Burden, Sorrel AU - Stanmore, Emma PY - 2024/4/30 TI - Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial JO - JMIR Res Protoc SP - e50922 VL - 13 KW - feasibility KW - usability KW - digital health KW - diet KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - ageing KW - aging KW - dietary KW - nutrition KW - hydration KW - community dwelling KW - RCT KW - randomized KW - controlled trial KW - controlled trials N2 - Background: Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. Objective: This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). Methods: This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). Results: Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants? self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. Conclusions: The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. Trial Registration: ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366 International Registered Report Identifier (IRRID): PRR1-10.2196/50922 UR - https://www.researchprotocols.org/2024/1/e50922 UR - http://dx.doi.org/10.2196/50922 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687981 ID - info:doi/10.2196/50922 ER - TY - JOUR AU - Wang, Jun-Wei AU - Zhu, Zhicheng AU - Shuling, Zhang AU - Fan, Jia AU - Jin, Yu AU - Gao, Zhan-Le AU - Chen, Wan-Di AU - Li, Xue PY - 2024/4/30 TI - Effectiveness of mHealth App?Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e51478 VL - 12 KW - mobile health KW - mHealth apps KW - children and adolescents KW - physical activity KW - physical fitness KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app?based interventions and potential moderators in this population are not yet fully understood. Objective: This study aims to review and analyze the effectiveness of mHealth app?based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app?based interventions in children and adolescents. Methods: We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes. Results: We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app?based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD ?0.97, 95% CI ?1.67 to ?0.28; P=.006) and BMI (weighted mean difference ?0.31 kg/m2, 95% CI ?0.60 to ?0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD ?0.35, 95% CI ?0.61 to ?0.10; P=.006). However, mHealth app?based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI ?0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI ?1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI ?0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD ?0.20, 95% CI ?0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI ?0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI ?0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI. Conclusions: Our meta-analysis suggests that mHealth app?based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app?based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research. Trial Registration: PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf UR - https://mhealth.jmir.org/2024/1/e51478 UR - http://dx.doi.org/10.2196/51478 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687568 ID - info:doi/10.2196/51478 ER - TY - JOUR AU - Olsen, Christine AU - Lungu, Adrian Daniel PY - 2024/4/30 TI - Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study JO - JMIR Form Res SP - e48185 VL - 8 KW - app KW - BMI KW - diet KW - exercise KW - health KW - Heia Meg KW - lifestyle change KW - longitudinal KW - mHealth KW - mobile health KW - motivation KW - nutrition KW - obese KW - obesity KW - overweight KW - physical activity KW - smartphone apps KW - weight N2 - Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. UR - https://formative.jmir.org/2024/1/e48185 UR - http://dx.doi.org/10.2196/48185 UR - http://www.ncbi.nlm.nih.gov/pubmed/38687565 ID - info:doi/10.2196/48185 ER - TY - JOUR AU - Zhu, Yue AU - Zhang, Ran AU - Yin, Shuluo AU - Sun, Yihui AU - Womer, Fay AU - Liu, Rongxun AU - Zeng, Sheng AU - Zhang, Xizhe AU - Wang, Fei PY - 2024/4/22 TI - Digital Dietary Behaviors in Individuals With Depression: Real-World Behavioral Observation JO - JMIR Public Health Surveill SP - e47428 VL - 10 KW - dietary behaviors KW - digital marker KW - depression KW - mental health KW - appetite disturbance KW - behavioral monitoring KW - eating pattern KW - electronic record KW - digital health KW - behavioral KW - surveillance N2 - Background: Depression is often accompanied by changes in behavior, including dietary behaviors. The relationship between dietary behaviors and depression has been widely studied, yet previous research has relied on self-reported data which is subject to recall bias. Electronic device?based behavioral monitoring offers the potential for objective, real-time data collection of a large amount of continuous, long-term behavior data in naturalistic settings. Objective: The study aims to characterize digital dietary behaviors in depression, and to determine whether these behaviors could be used to detect depression. Methods: A total of 3310 students (2222 healthy controls [HCs], 916 with mild depression, and 172 with moderate-severe depression) were recruited for the study of their dietary behaviors via electronic records over a 1-month period, and depression severity was assessed in the middle of the month. The differences in dietary behaviors across the HCs, mild depression, and moderate-severe depression were determined by ANCOVA (analyses of covariance) with age, gender, BMI, and educational level as covariates. Multivariate logistic regression analyses were used to examine the association between dietary behaviors and depression severity. Support vector machine analysis was used to determine whether changes in dietary behaviors could detect mild and moderate-severe depression. Results: The study found that individuals with moderate-severe depression had more irregular eating patterns, more fluctuated feeding times, spent more money on dinner, less diverse food choices, as well as eating breakfast less frequently, and preferred to eat only lunch and dinner, compared with HCs. Moderate-severe depression was found to be negatively associated with the daily 3 regular meals pattern (breakfast-lunch-dinner pattern; OR 0.467, 95% CI 0.239-0.912), and mild depression was positively associated with daily lunch and dinner pattern (OR 1.460, 95% CI 1.016-2.100). These changes in digital dietary behaviors were able to detect mild and moderate-severe depression (accuracy=0.53, precision=0.60), with better accuracy for detecting moderate-severe depression (accuracy=0.67, precision=0.64). Conclusions: This is the first study to develop a profile of changes in digital dietary behaviors in individuals with depression using real-world behavioral monitoring. The results suggest that digital markers may be a promising approach for detecting depression. UR - https://publichealth.jmir.org/2024/1/e47428 UR - http://dx.doi.org/10.2196/47428 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648087 ID - info:doi/10.2196/47428 ER - TY - JOUR AU - Han, Yunmin AU - Sung, Hoyong AU - Kim, Geonhui AU - Ryu, Yeun AU - Yoon, Jiyeon AU - Kim, Soo Yeon PY - 2024/4/18 TI - Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial JO - JMIR Cardio SP - e42402 VL - 8 KW - weight loss KW - obesity KW - health education KW - self-management KW - health promotion KW - tailored feedback KW - web-based intervention KW - behavior change N2 - Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI?23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of ?0.74 (SD 1.96) kg (P=.03) and ?1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were ?1.65 (SD 2.64) kg in the MINE group, ?1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 UR - https://cardio.jmir.org/2024/1/e42402 UR - http://dx.doi.org/10.2196/42402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635975 ID - info:doi/10.2196/42402 ER - TY - JOUR AU - Wang, Hao AU - Du, Huaidong AU - Guan, Yunqi AU - Zhong, Jieming AU - Li, Na AU - Pan, Jin AU - Yu, Min PY - 2024/4/17 TI - Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study JO - JMIR Public Health Surveill SP - e50996 VL - 10 KW - depression symptoms KW - muscle-strengthening exercise KW - adolescents KW - cross-sectional study N2 - Background: Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. Objective: This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. Methods: A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. Results: Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ?3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively. Conclusions: The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms. UR - https://publichealth.jmir.org/2024/1/e50996 UR - http://dx.doi.org/10.2196/50996 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630529 ID - info:doi/10.2196/50996 ER - TY - JOUR AU - Lee, Lachlan AU - Hall, Rosemary AU - Stanley, James AU - Krebs, Jeremy PY - 2024/4/15 TI - Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e52074 VL - 12 KW - dietary assessment KW - diet KW - dietary KW - nutrition KW - mobile phone apps KW - image-based dietary assessment KW - nutritional epidemiology KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - image KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - cross-over KW - images KW - photo KW - photographs KW - photos KW - photograph KW - assessment KW - prompt KW - prompts KW - nudge KW - nudges KW - food KW - meal KW - meals KW - consumption KW - behaviour change KW - behavior change N2 - Background: Accurately assessing an individual?s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message. Objective: This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool. Methods: This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment. Results: A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P?.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed. Conclusions: Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness. UR - https://mhealth.jmir.org/2024/1/e52074 UR - http://dx.doi.org/10.2196/52074 ID - info:doi/10.2196/52074 ER - TY - JOUR AU - Abdullah, Rifham Shazana AU - Wan Mohd Zin, Mona Ruziana AU - Azizul, Hayati Nur AU - Sulaiman, Suffia Nur AU - Khalid, Mustafa Norhayati AU - Mohd Salim Mullahi Jahn, Jahn Roshan AU - Khalil, Nazrin Muhamad Khairul AU - Abu Seman, Norhashimah AU - Zainal Abidin, Azlin Nur AU - Ali, Azizan AU - Tan, Zhuan You AU - Omar, Azahadi AU - Seman, Zamtira AU - Yahya, Abqariyah AU - Md Noh, Fairulnizal Mohd PY - 2024/4/10 TI - The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial JO - JMIR Form Res SP - e51542 VL - 8 KW - intermittent fasting KW - dry fasting KW - healthy plate KW - obesity KW - overweight N2 - Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference ?1.68; P<.001), BMI (difference ?0.62; P<.001), body fat percentage (difference ?0.921; P<.001), body fat mass (difference ?1.28; P<.001), and visceral fat area (difference ?4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference ?1.428; P=.003), BMI (difference ?0.522; P=.005), body fat percentage (difference ?1.591; P<.001), body fat mass (difference ?1.501; P<.001), visceral fat area (difference ?7.130; P<.001), waist circumference (difference ?2.304; P=.001), and hip circumference (difference ?1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference ?3.206; P<.001, HP difference ?2.675; P=.004) and hip (IFHP difference ?2.443; P<.001; HP difference ?2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference ?2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. UR - https://formative.jmir.org/2024/1/e51542 UR - http://dx.doi.org/10.2196/51542 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598283 ID - info:doi/10.2196/51542 ER - TY - JOUR AU - Lozada-Tequeanes, Lilia Ana AU - Théodore, L. Florence AU - Kim-Herrera, Edith AU - García-Guerra, Armando AU - Quezada-Sánchez, D. Amado AU - Alvarado-Casas, Rocio AU - Bonvecchio, Anabelle PY - 2024/4/9 TI - Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e55509 VL - 12 KW - effectiveness KW - feasibility KW - mHealth KW - SMS text message KW - mixed methods KW - infant obesity KW - physical activity KW - healthy feeding KW - children KW - COVID-19 KW - Mexico N2 - Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children?s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants? experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was ?good,? ?useful,? and ?helpful? for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 UR - https://mhealth.jmir.org/2024/1/e55509 UR - http://dx.doi.org/10.2196/55509 UR - http://www.ncbi.nlm.nih.gov/pubmed/38592753 ID - info:doi/10.2196/55509 ER - TY - JOUR AU - Lim, Heemoon AU - Lee, Hyejung PY - 2024/4/5 TI - Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea JO - JMIR Public Health Surveill SP - e51581 VL - 10 KW - BMI KW - body mass index KW - childhood obesity KW - cluster analysis KW - healthy eating KW - healthy lifestyle KW - pediatric obesity KW - preschool child KW - prevention KW - unsupervised machine learning N2 - Background: Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life. Objective: This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity. Methods: A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children?s eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children?s BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster. Results: At both ages (ages 5 and 6 years), we identified 4 clusters based on the children?s eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother?s education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father?s education level (P=.02) at the age of 6 years. Conclusions: Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child?s eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels. UR - https://publichealth.jmir.org/2024/1/e51581 UR - http://dx.doi.org/10.2196/51581 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578687 ID - info:doi/10.2196/51581 ER - TY - JOUR AU - Anastasiadou, Dimitra AU - Herrero, Pol AU - Garcia-Royo, Paula AU - Vázquez-De Sebastián, Julia AU - Slater, Mel AU - Spanlang, Bernhard AU - Álvarez de la Campa, Elena AU - Ciudin, Andreea AU - Comas, Marta AU - Ramos-Quiroga, Antoni Josep AU - Lusilla-Palacios, Pilar PY - 2024/4/5 TI - Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial JO - J Med Internet Res SP - e51558 VL - 26 KW - obesity KW - virtual reality KW - psychological treatment KW - embodiment KW - motivational interviewing KW - self-conversation N2 - Background: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. Objective: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. Methods: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d?Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. Results: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (?=?.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (?=?.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (?=.71; P=.01) and emotional eating (?=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (?=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI ?0.30 to 0.89). Conclusions: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. Trial Registration: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557 UR - https://www.jmir.org/2024/1/e51558 UR - http://dx.doi.org/10.2196/51558 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578667 ID - info:doi/10.2196/51558 ER - TY - JOUR AU - Arguello, Diego PY - 2024/4/3 TI - Authors? Reply: Ambiguity in Statistical Analysis Methods and Nonconformity With Prespecified Commitment to Data Sharing in a Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e57422 VL - 26 KW - prolonged sedentary behavior KW - sedentary behavior KW - sit-to-stand desks KW - treadmill desks KW - physical activity promotion KW - workplace wellness KW - seated office workers KW - move more and sit less UR - https://www.jmir.org/2024/1/e57422 UR - http://dx.doi.org/10.2196/57422 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568734 ID - info:doi/10.2196/57422 ER - TY - JOUR AU - Jamshidi-Naeini, Yasaman AU - Golzarri-Arroyo, Lilian AU - Thapa, K. Deependra AU - Brown, W. Andrew AU - Kpormegbey, E. Daniel AU - Allison, B. David PY - 2024/4/3 TI - Ambiguity in Statistical Analysis Methods and Nonconformity With Prespecified Commitment to Data Sharing in a Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e54090 VL - 26 KW - cluster randomized trial KW - clustering KW - nesting KW - data availability KW - random allocation KW - data sharing KW - reproducibility UR - https://www.jmir.org/2024/1/e54090 UR - http://dx.doi.org/10.2196/54090 UR - http://www.ncbi.nlm.nih.gov/pubmed/38568721 ID - info:doi/10.2196/54090 ER - TY - JOUR AU - Avila-Montiel, Diana AU - Vilchis-Gil, Jenny AU - Miranda-Lora, Liliana América AU - Velázquez-López, Lubia AU - Klünder-Klünder, Miguel PY - 2024/4/1 TI - The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e54783 VL - 13 KW - e-Health nutrition education KW - ultraprocessed foods KW - malnutrition KW - children KW - Mexico KW - intervention KW - obesity KW - food KW - food selection KW - labeling KW - package labeling N2 - Background: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. Objective: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. Methods: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. Results: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. Conclusions: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. Trial Registration: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473 International Registered Report Identifier (IRRID): PRR1-10.2196/54783 UR - https://www.researchprotocols.org/2024/1/e54783 UR - http://dx.doi.org/10.2196/54783 UR - http://www.ncbi.nlm.nih.gov/pubmed/38557591 ID - info:doi/10.2196/54783 ER - TY - JOUR AU - Miller, N. Hailey AU - Gallis, A. John AU - Berger, B. Miriam AU - Askew, Sandy AU - Egger, R. Joseph AU - Kay, C. Melissa AU - Finkelstein, Andrew Eric AU - de Leon, Mia AU - DeVries, Abigail AU - Brewer, Ashley AU - Holder, Gwyther Marni AU - Bennett, G. Gary PY - 2024/3/28 TI - Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial JO - J Med Internet Res SP - e50330 VL - 26 KW - weight gain prevention KW - digital health KW - pragmatic clinical trial KW - primary care KW - health disparities KW - obesity KW - obese KW - prevalence KW - weight management KW - overweight KW - intervention N2 - Background: The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care. Objective: This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers. Methods: Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ?3% weight gain in each arm at 24 months after randomization?our primary outcome?using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point. Results: We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non?Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ?3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI ?4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI ?12.1 to 11.0 percentage points). Conclusions: In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention. Trial Registration: ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6926-7 UR - https://www.jmir.org/2024/1/e50330 UR - http://dx.doi.org/10.2196/50330 UR - http://www.ncbi.nlm.nih.gov/pubmed/38416574 ID - info:doi/10.2196/50330 ER - TY - JOUR AU - Li, Shiyu AU - Du, Yan AU - Miao, Hongyu AU - Sharma, Kumar AU - Li, Chengdong AU - Yin, Zenong AU - Brimhall, Bradley AU - Wang, Jing PY - 2024/3/20 TI - Understanding Heterogeneity in Individual Responses to Digital Lifestyle Intervention Through Self-Monitoring Adherence Trajectories in Adults With Overweight or Obesity: Secondary Analysis of a 6-Month Randomized Controlled Trial JO - J Med Internet Res SP - e53294 VL - 26 KW - self-monitoring KW - adherence KW - weight loss KW - digital technology KW - behavior change KW - group-based trajectory modeling KW - precision health KW - mobile phone N2 - Background: Achieving clinically significant weight loss through lifestyle interventions for obesity management is challenging for most individuals. Improving intervention effectiveness involves early identification of intervention nonresponders and providing them with timely, tailored interventions. Early and frequent self-monitoring (SM) adherence predicts later weight loss success, making it a potential indicator for identifying nonresponders in the initial phase. Objective: This study aims to identify clinically meaningful participant subgroups based on longitudinal adherence to SM of diet, activity, and weight over 6 months as well as psychological predictors of participant subgroups from a self-determination theory (SDT) perspective. Methods: This was a secondary data analysis of a 6-month digital lifestyle intervention for adults with overweight or obesity. The participants were instructed to perform daily SM on 3 targets: diet, activity, and weight. Data from 50 participants (mean age: 53.0, SD 12.6 y) were analyzed. Group-based multitrajectory modeling was performed to identify subgroups with distinct trajectories of SM adherence across the 3 SM targets. Differences between subgroups were examined for changes in clinical outcomes (ie, body weight, hemoglobin A1c) and SDT constructs (ie, eating-related autonomous motivation and perceived competence for diet) over 6 months using linear mixed models. Results: Two distinct SM trajectory subgroups emerged: the Lower SM group (21/50, 42%), characterized by all-around low and rapidly declining SM, and the Higher SM group (29/50, 58%), characterized by moderate and declining diet and weight SM with high activity SM. Since week 2, participants in the Lower SM group exhibited significantly lower levels of diet (P=.003), activity (P=.002), and weight SM (P=.02) compared with the Higher SM group. In terms of clinical outcomes, the Higher SM group achieved a significant reduction in body weight (estimate: ?6.06, SD 0.87 kg; P<.001) and hemoglobin A1c (estimate: ?0.38, SD 0.11%; P=.02), whereas the Lower SM group exhibited no improvements. For SDT constructs, both groups maintained high levels of autonomous motivation for over 6 months. However, the Lower SM group experienced a significant decline in perceived competence (P=.005) compared with the Higher SM group, which maintained a high level of perceived competence throughout the intervention (P=.09). Conclusions: The presence of the Lower SM group highlights the value of using longitudinal SM adherence trajectories as an intervention response indicator. Future adaptive trials should identify nonresponders within the initial 2 weeks based on their SM adherence and integrate intervention strategies to enhance perceived competence in diet to benefit nonresponders. Trial Registration: ClinicalTrials.gov NCT05071287; https://clinicaltrials.gov/study/NCT05071287 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106845 UR - https://www.jmir.org/2024/1/e53294 UR - http://dx.doi.org/10.2196/53294 UR - http://www.ncbi.nlm.nih.gov/pubmed/38506903 ID - info:doi/10.2196/53294 ER - TY - JOUR AU - Delaney, Tessa AU - Jackson, Jacklyn AU - Lecathelinais, Christophe AU - Clinton-McHarg, Tara AU - Lamont, Hannah AU - Yoong, Lin Sze AU - Wolfenden, Luke AU - Sutherland, Rachel AU - Wyse, Rebecca PY - 2024/3/19 TI - Long-Term Effectiveness of a Multi-Strategy Choice Architecture Intervention in Increasing Healthy Food Choices of High-School Students From Online Canteens (Click & Crunch High Schools): Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e51108 VL - 26 KW - randomized controlled trial KW - web-based ordering systems KW - ordering KW - menu KW - menus KW - prompt KW - prompts KW - prompting KW - nudge KW - nudges KW - behavior change KW - behaviour change KW - digital intervention KW - lunch KW - school KW - menu labelling KW - behavioral economics KW - secondary school KW - meal delivery apps KW - public health nutrition KW - meal KW - meals KW - nutrition KW - nutritional KW - diet KW - eating KW - food KW - schools KW - student KW - students KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - purchase KW - purchasing KW - canteen KW - canteens KW - choice KW - choices KW - architecture N2 - Background: School canteens are a recommended setting to influence adolescent nutrition due to their scope to improve student food choices. Online lunch ordering systems (?online canteens?) are increasingly used and represent attractive infrastructure to implement choice architecture interventions that nudge users toward healthier food choices. A recent cluster randomized controlled trial demonstrated the short-term effectiveness (2-month follow-up) of a choice architecture intervention to increase the healthiness of foods purchased by high school students from online canteens. However, there is little evidence regarding the long-term effectiveness of choice architecture interventions targeting adolescent food purchases, particularly those delivered online. Objective: This study aimed to determine the long-term effectiveness of a multi-strategy choice architecture intervention embedded within online canteen infrastructure in high schools at a 15-month follow-up. Methods: A cluster randomized controlled trial was undertaken with 1331 students (from 9 high schools) in New South Wales, Australia. Schools were randomized to receive the automated choice architecture intervention (including menu labeling, positioning, feedback, and prompting strategies) or the control (standard online ordering). The foods purchased were classified according to the New South Wales Healthy Canteen strategy as either ?everyday,? ?occasional,? or ?should not be sold.? Primary outcomes were the average proportion of ?everyday,? ?occasional,? and ?should not be sold? items purchased per student. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Outcomes were assessed using routine data collected by the online canteen. Results: From baseline to 15-month follow-up, on average, students in the intervention group ordered significantly more ?everyday? items (+11.5%, 95% CI 7.3% to 15.6%; P<.001), and significantly fewer ?occasional? (?5.4%, 95% CI ?9.4% to ?1.5%; P=.007) and ?should not be sold? items (?6%, 95% CI ?9.1% to ?2.9%; P<.001), relative to controls. There were no between-group differences over time in the mean energy, saturated fat, sugar, or sodium content of lunch orders. Conclusions: Given their longer-term effectiveness, choice architecture interventions delivered via online canteens may represent a promising option for policy makers to support healthy eating among high school students. Trial Registration: Australian Clinical Trials ACTRN12620001338954, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380546?; Open Science Framework osf.io/h8zfr, https://osf.io/h8zfr/ UR - https://www.jmir.org/2024/1/e51108 UR - http://dx.doi.org/10.2196/51108 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502177 ID - info:doi/10.2196/51108 ER - TY - JOUR AU - Edwards, Katie AU - Croker, Helen AU - Farrow, Claire AU - Haycraft, Emma AU - Herle, Moritz AU - Llewellyn, Clare AU - Pickard, Abigail AU - Blissett, Jacqueline PY - 2024/3/19 TI - Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e55193 VL - 13 KW - ecological momentary assessment KW - avid eating KW - children?s eating behavior KW - parental feeding practices KW - feeding behaviour KW - parent KW - children KW - eating behaviour KW - obesity KW - environmental factors KW - observational study KW - feeding KW - United Kingdom N2 - Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents? daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children?s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers? daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children?s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 UR - https://www.researchprotocols.org/2024/1/e55193 UR - http://dx.doi.org/10.2196/55193 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502178 ID - info:doi/10.2196/55193 ER - TY - JOUR AU - Lee, J. David AU - O'Donnell, K. Elizabeth AU - Raje, Noopur AU - Panaroni, Cristina AU - Redd, Robert AU - Ligibel, Jennifer AU - Sears, D. Dorothy AU - Nadeem, Omar AU - Ghobrial, M. Irene AU - Marinac, R. Catherine PY - 2024/3/11 TI - Design and Rationale of Prolonged Nightly Fasting for Multiple Myeloma Prevention (PROFAST): Protocol for a Randomized Controlled Pilot Trial JO - JMIR Res Protoc SP - e51368 VL - 13 KW - MGUS KW - smoldering myeloma KW - cancer prevention KW - intermittent fasting KW - fasting KW - myeloma KW - cancer KW - oncology KW - oncological KW - overweight KW - weight KW - obese KW - obesity KW - tumor KW - tumors KW - RCT KW - randomized KW - controlled trial KW - controlled trials KW - body mass index KW - BMI KW - blood KW - hematology KW - hematological KW - gammopathy KW - eating KW - diet KW - dietary N2 - Background: Obesity is an established, modifiable risk factor of multiple myeloma (MM); yet, no lifestyle interventions are routinely recommended for patients with overweight or obesity with MM precursor conditions. Prolonged nightly fasting is a simple, practical dietary regimen supported by research, suggesting that the synchronization of feeding-fasting timing with sleep-wake cycles favorably affects metabolic pathways implicated in MM. We describe the design and rationale of a randomized controlled pilot trial evaluating the efficacy of a regular, prolonged nighttime fasting schedule among individuals with overweight or obesity at high risk for developing MM or a related lymphoid malignancy. Objective: We aim to investigate the effects of 4-month prolonged nightly fasting on body composition and tumor biomarkers among individuals with overweight or obesity with monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or smoldering Waldenström macroglobulinemia (SWM). Methods: Individuals with MGUS, SMM, or SWM aged ?18 years and a BMI of ?25 kg/m2 are randomized to either a 14-hour nighttime fasting intervention or a healthy lifestyle education control group. Participants? baseline diet and lifestyle patterns are characterized through two 24-hour dietary recalls: questionnaires querying demographic, comorbidity, lifestyle, and quality-of-life information; and wrist actigraphy measurements for 7 days. Fasting intervention participants are supported through one-on-one telephone counseling by a health coach and automated SMS text messaging to support fasting goals. Primary end points of body composition, including visceral and subcutaneous fat (by dual-energy x-ray absorptiometry); bone marrow adiposity (by bone marrow histology); and tumor biomarkers, specifically M-proteins and serum free light-chain concentrations (by gel-based and serum free light-chain assays), are assessed at baseline and after the 4-month study period; changes therein from baseline are evaluated using a repeated measures mixed-effects model that accounts for the correlation between baseline and follow-up measures and is generally robust to missing data. Feasibility is assessed as participant retention (percent dropout in each arm) and percentage of days participants achieved a ?14-hour fast. Results: The PROlonged nightly FASTing (PROFAST) study was funded in June 2022. Participant recruitment commenced in April 2023. As of July 2023, six participants consented to the study. The study is expected to be completed by April 2024, and data analysis and results are expected to be published in the first quarter of 2025. Conclusions: PROFAST serves as an important first step in exploring the premise that prolonged nightly fasting is a strategy to control obesity and obesity-related mechanisms of myelomagenesis. In evaluating the feasibility and impact of prolonged nightly fasting on body composition, bone marrow adipose tissue, and biomarkers of tumor burden, this pilot study may generate hypotheses regarding metabolic mechanisms underlying MM development and ultimately inform clinical and public health strategies for MM prevention. Trial Registration: ClinicalTrials.gov NCT05565638; http://clinicaltrials.gov/ct2/show/NCT05565638 International Registered Report Identifier (IRRID): DERR1-10.2196/51368 UR - https://www.researchprotocols.org/2024/1/e51368 UR - http://dx.doi.org/10.2196/51368 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466984 ID - info:doi/10.2196/51368 ER - TY - JOUR AU - Ansari, Ridwan Muhammad AU - Kodriati, Nurul AU - Pertiwi, Putri Ariani Arista AU - Dewi, Tetra Fatwa Sari PY - 2024/3/5 TI - The Effectiveness of a Telenutrition Intervention to Improve Dietary Behavior and Physical Activity Among Adolescents With Obesity: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e53282 VL - 13 KW - telehealth KW - obesity KW - telenutrition KW - adolescent KW - behavior change KW - virtual counseling KW - teenager KW - young adult KW - food intake KW - dietary pattern KW - intervention N2 - Background: The global obesity pandemic among adolescents is becoming a public health issue throughout the world. Telehealth use has significantly increased during and after the COVID-19 pandemic, including its application in adolescent obesity prevention and treatment. Objective: This review aims to synthesize the evidence on the effectiveness of telenutrition in improving dietary behavior and physical activity in adolescents with obesity. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guideline will be used to structure this protocol. The focus of the systematic review is guided by the population, intervention, comparator, and outcome (PICO) framework. A systematic search of Science Direct, PubMed, Cochrane, Embase, JMIR, ProQuest, and Google scholar databases will be conducted. Two authors will screen the titles and abstracts of identified studies independently and select studies according to the eligibility criteria. The full-text reading will be done independently by 2 reviewers to assess final eligibility. Any discrepancies will then be discussed and resolved. The Cochrane Collaboration Risk of Bias tool was used to assess the risk of bias; a descriptive analysis will summarize the effectiveness of the telenutrition or any type of telehealth intervention used. Results: The systematic review is expected to be completed by the end of March 2024. The ongoing screening and review of the articles are currently being conducted. Conclusions: This systematic review aims to summarize the effectiveness, features, design process, usability, and coherence of a telenutrition intervention using behavior change theory to improve dietary patterns and physical activity among adolescents with obesity. It will identify areas for improvement and best practices, informing the development of more useful and engaging telenutrition interventions for adolescents. Trial Registration: PROSPERO CRD42023458336; http://tinyurl.com/cp46fjj9 International Registered Report Identifier (IRRID): DERR1-10.2196/53282 UR - https://www.researchprotocols.org/2024/1/e53282 UR - http://dx.doi.org/10.2196/53282 UR - http://www.ncbi.nlm.nih.gov/pubmed/38441950 ID - info:doi/10.2196/53282 ER - TY - JOUR AU - O'Hara, Cathal AU - Gibney, R. Eileen PY - 2024/2/14 TI - Dietary Intake Assessment Using a Novel, Generic Meal?Based Recall and a 24-Hour Recall: Comparison Study JO - J Med Internet Res SP - e48817 VL - 26 KW - meal patterns KW - eating behaviors KW - eating occasions KW - nutrition assessment KW - dietary intake assessment KW - 24-hour recall KW - relative validity N2 - Background: Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods. Objective: This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR). Methods: Participants completed a web-based, generic meal?based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant. Results: In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6% (IQR 2.6%-13.2%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83%) variables, moderate for 2 (9%) variables, and large for 2 (9%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8% (85/161) to 84.5% (136/161). Conclusions: A generic meal?based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall. UR - https://www.jmir.org/2024/1/e48817 UR - http://dx.doi.org/10.2196/48817 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354039 ID - info:doi/10.2196/48817 ER - TY - JOUR AU - Murakami, Kentaro AU - Shinozaki, Nana AU - Okuhara, Tsuyoshi AU - McCaffrey, A. Tracy AU - Livingstone, E. M. Barbara PY - 2024/2/14 TI - Prevalence and Correlates of Dietary and Nutrition Information Seeking Through Various Web-Based and Offline Media Sources Among Japanese Adults: Web-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e54805 VL - 10 KW - nutrition KW - diet KW - information seeking KW - health literacy KW - food literacy KW - diet quality KW - Japan N2 - Background: The advent of the internet has changed the landscape of available nutrition information. However, little is known about people?s information-seeking behavior toward healthy eating and its potential consequences. Objective: We aimed to examine the prevalence and correlates of nutrition information seeking from various web-based and offline media sources. Methods: This cross-sectional study included 5998 Japanese adults aged 20 to 79 years participating in a web-based questionnaire survey (February and March 2023). The dependent variable was the regular use of web-based and offline media as a reliable source of nutrition information. The main independent variables included health literacy, food literacy, and diet quality, which were assessed using validated tools, as well as sociodemographic factors (sex, age, education level, and nutrition- and health-related occupations). Results: The top source of nutrition information was television (1973/5998, 32.89%), followed by web searches (1333/5998, 22.22%), websites of government and medical manufacturers (997/5998, 16.62%), newspapers (901/5998, 15.02%), books and magazines (697/5998, 11.62%), and video sites (eg, YouTube; 634/5998, 10.57%). Multivariable logistic regression showed that higher health literacy was associated with higher odds of using all the individual sources examined; odds ratios (ORs) for 1-point score increase ranged from 1.27 (95% CI 1.09-1.49) to 1.81 (95% CI 1.57-2.09). By contrast, food literacy was inversely associated with the use of television (OR 0.65, 95% CI 0.55-0.77), whereas it was positively associated with the use of websites of government and medical manufacturers (OR 1.98, 95% CI 1.62-2.44), books and magazines (OR 2.09, 95% CI 1.64-2.66), and video sites (OR 1.53, 95% CI 1.19-1.96). Furthermore, diet quality was positively associated with the use of newspapers (OR 1.02, 95% CI 1.01-1.03) and books and magazines (OR 1.03, 95% CI 1.02-1.04). Being female was associated with using television and books and magazines, whereas being male was associated with using websites of government and medical manufacturers, newspapers, and video sites. Age was positively associated with using newspapers and inversely associated with using websites of government and medical manufacturers and video sites. People with higher education were more likely to refer to websites of government and medical manufacturers and newspapers but less likely to use television and video sites. Dietitians were more likely to use websites of government and medical manufacturers and books and magazines than the general public but less likely to use television and video sites. Conclusions: We identified various web-based and offline media sources regularly used by Japanese adults when seeking nutrition information, and their correlates varied widely. A lack of positive associations between the use of the top 2 major sources (television and web searches) and food literacy or diet quality is highlighted. These findings provide useful insights into the potential for developing and disseminating evidence-based health promotion materials. UR - https://publichealth.jmir.org/2024/1/e54805 UR - http://dx.doi.org/10.2196/54805 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354021 ID - info:doi/10.2196/54805 ER - TY - JOUR AU - Buss, Helen Vera AU - Barr, Margo AU - Parker, M. Sharon AU - Kabir, Alamgir AU - Lau, S. Annie Y. AU - Liaw, Siaw-Teng AU - Stocks, Nigel AU - Harris, F. Mark PY - 2024/2/9 TI - Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study JO - JMIR Mhealth Uhealth SP - e45942 VL - 12 KW - health literacy KW - primary health care KW - mobile application KW - overweight KW - vulnerable populations KW - health behavior KW - mHealth KW - obesity KW - weight loss KW - mysnapp app KW - mobile phone N2 - Background: The Health eLiteracy for Prevention in General Practice trial is a primary health care?based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. Objective: This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. Methods: In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants? choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants? questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. Results: Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. Conclusions: Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023239 UR - https://mhealth.jmir.org/2024/1/e45942 UR - http://dx.doi.org/10.2196/45942 UR - http://www.ncbi.nlm.nih.gov/pubmed/38335014 ID - info:doi/10.2196/45942 ER - TY - JOUR AU - Cui, Cancan AU - Wu, Zhiyuan AU - Zheng, Jia AU - Chu, Jiaqi AU - Zhu, Jiajing AU - Qi, Yitian AU - Zhang, Zhenming AU - Wang, Zhijia AU - Zhang, Mengchao AU - Mo, Zhanhao AU - Cheng, Liangkai AU - Ding, Lei AU - Kang, Xiaoping AU - Liu, Lin AU - Zhang, Te PY - 2024/2/8 TI - Arterial Stiffness and Obesity as Predictors of Diabetes: Longitudinal Cohort Study JO - JMIR Public Health Surveill SP - e46088 VL - 10 KW - arterial stiffness KW - baPWV KW - brachial-ankle pulse wave velocity KW - cohort analysis KW - obesity and abdominal obesity KW - type 2 diabetes N2 - Background: Previous studies have confirmed the separate effect of arterial stiffness and obesity on type 2 diabetes; however, the joint effect of arterial stiffness and obesity on diabetes onset remains unclear. Objective: This study aimed to propose the concept of arterial stiffness obesity phenotype and explore the risk stratification capacity for diabetes. Methods: This longitudinal cohort study used baseline data of 12,298 participants from Beijing Xiaotangshan Examination Center between 2008 and 2013 and then annually followed them until incident diabetes or 2019. BMI (waist circumference) and brachial-ankle pulse wave velocity were measured to define arterial stiffness abdominal obesity phenotype. The Cox proportional hazard model was used to estimate the hazard ratio (HR) and 95% CI. Results: Of the 12,298 participants, the mean baseline age was 51.2 (SD 13.6) years, and 8448 (68.7%) were male. After a median follow-up of 5.0 (IQR 2.0-8.0) years, 1240 (10.1%) participants developed diabetes. Compared with the ideal vascular function and nonobese group, the highest risk of diabetes was observed in the elevated arterial stiffness and obese group (HR 1.94, 95% CI 1.60-2.35). Those with exclusive arterial stiffness or obesity exhibited a similar risk of diabetes, and the adjusted HRs were 1.63 (95% CI 1.37-1.94) and 1.64 (95% CI 1.32-2.04), respectively. Consistent results were observed in multiple sensitivity analyses, among subgroups of age and fasting glucose level, and alternatively using arterial stiffness abdominal obesity phenotype. Conclusions: This study proposed the concept of arterial stiffness abdominal obesity phenotype, which could improve the risk stratification and management of diabetes. The clinical significance of arterial stiffness abdominal obesity phenotype needs further validation for other cardiometabolic disorders. UR - https://publichealth.jmir.org/2024/1/e46088 UR - http://dx.doi.org/10.2196/46088 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329798 ID - info:doi/10.2196/46088 ER - TY - JOUR AU - Gannamani, Rahul AU - Castela Forte, José AU - Folkertsma, Pytrik AU - Hermans, Sven AU - Kumaraswamy, Sridhar AU - van Dam, Sipko AU - Chavannes, Niels AU - van Os, Hendrikus AU - Pijl, Hanno AU - Wolffenbuttel, R. Bruce H. PY - 2024/2/8 TI - A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort JO - JMIR Form Res SP - e38891 VL - 8 KW - lifestyle intervention KW - prevention KW - obesity KW - overweight KW - weight loss KW - digital health KW - intervention KW - weight KW - pilot KW - digital KW - data KW - Fogg Behavior Model N2 - Background: Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. Objective: The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. Methods: Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. Results: Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. Conclusions: Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL. UR - https://formative.jmir.org/2024/1/e38891 UR - http://dx.doi.org/10.2196/38891 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329792 ID - info:doi/10.2196/38891 ER - TY - JOUR AU - Chen, Jiaheng AU - Li, Ting Yu AU - Niu, Zimin AU - He, Zhanpeng AU - Xie, Jie Yao AU - Hernandez, Jose AU - Huang, Wenyong AU - Wang, X. Harry H. AU - PY - 2024/2/6 TI - Association of Visceral Obesity Indices With Incident Diabetic Retinopathy in Patients With Diabetes: Prospective Cohort Study JO - JMIR Public Health Surveill SP - e48120 VL - 10 KW - Chinese visceral adiposity index KW - community-based cohort KW - diabetic retinopathy KW - lipid accumulation product KW - visceral adiposity index KW - visceral obesity indices N2 - Background: Visceral adipose tissue plays an active role in the pathogenesis of type 2 diabetes and vascular dysfunction. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) have been proposed as simple and validated surrogate indices for measuring visceral adipose tissue. However, the evidence from prospective studies on the associations between these novel indices of visceral obesity and diabetic retinopathy (DR) remains scant. Objective: This study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes. Methods: This was a prospective cohort study conducted in Guangzhou in southern China. We collected baseline data between November 2017 and July 2020, while on-site follow-up visits were conducted annually until January 2022. The study participants consisted of 1403 patients with a clinical diagnosis of diabetes, referred from primary care, who were free of DR at baseline. The LAP, VAI, and CVAI levels were calculated by sex-specific equations based on anthropometric and biochemical parameters. DR was assessed using 7-field color stereoscopic fundus photographs and graded according to the modified Airlie House Classification scheme. Time-dependent Cox proportional hazard models were constructed to estimate the hazard ratios with 95% CIs. Restricted cubic spline curves were fitted to examine the dose-response relationship between the 3 indices of visceral obesity and new-onset DR. Subgroup analyses were performed to investigate the potential effect modifiers. Results: The mean age of study participants was 64.5 (SD 7.6) years, and over half (816/1403, 58.2%) were female. During a median follow-up of 2.13 years, 406 DR events were observed. A 1-SD increment in LAP, VAI, or CVAI was consistently associated with increased risk for new-onset DR, with a multivariable?adjusted hazard ratio of 1.24 (95% CI 1.09-1.41; P=.001), 1.22 (95% CI 1.09-1.36; P<.001), and 1.48 (95% CI 1.19-1.85; P=.001), respectively. Similar patterns were observed across tertiles in LAP (P for trend=.001), VAI (P for trend<.001), and CVAI (P for trend=.009). Patients in the highest tertile of LAP, VAI, and CVAI had an 84%, 86%, and 82% higher hazard of DR, respectively, compared to those in the lowest tertile. A nonlinear dose-response relationship with incident DR was noted for LAP and VAI (both P for nonlinearity<.05), but not for CVAI (P for nonlinearity=.51). We did not detect the presence of effect modification by age, sex, duration of diabetes, BMI, or comorbidity (all P for interaction>.10). Conclusions: Visceral obesity, as measured by LAP, VAI, or CVAI, is independently associated with increased risk for new-onset DR in Chinese patients with diabetes. Our findings may suggest the necessity of incorporating regular monitoring of visceral obesity indices into routine clinical practice to enhance population-based prevention for DR. UR - https://publichealth.jmir.org/2024/1/e48120 UR - http://dx.doi.org/10.2196/48120 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319705 ID - info:doi/10.2196/48120 ER - TY - JOUR AU - Mohd Saad, Noraini AU - Mohamad, Mariam AU - Mat Ruzlin, Nadira Aimi PY - 2024/1/31 TI - Web-Based Intervention to Act for Weight Loss in Adults With Type 2 Diabetes With Obesity (Chance2Act): Protocol for a Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e48313 VL - 13 KW - readiness to change KW - behavior change KW - diabetes KW - overweight KW - weight reduction KW - eHealth KW - obesity N2 - Background: In adults with type 2 diabetes (T2D), weight loss can improve hemoglobin A1c, blood pressure, and triglycerides, and reduce the frequency of medications needed. Unfortunately, a large proportion of these individuals are not ready to initiate weight efforts, making existing obesity management strategies less effective. Many digital health interventions aim at weight loss, but there is still limited evidence on their effectiveness in changing weight loss behavior, especially in adults with T2D. Objective: This study aims to develop and validate ?Chance2Act,? a new web-based intervention, designed specifically to facilitate behavioral change in adults with T2D with obesity who are not ready to act toward weight loss. Then, the effectiveness of the newly developed intervention will be determined from a nonrandomized controlled trial. Methods: A web-based intervention will be developed based on the Transtheoretical Model targeting adults with T2D with obesity who are not ready to change for weight loss. Phase 1 will involve the development and validation of the web-based health intervention module. In phase 2, a nonrandomized controlled trial will be conducted in 2 government health clinics selected by the investigator. This is an unblinded study with a parallel assignment (ie, intervention vs control [usual care] with an allocation ratio of 1:1). A total of 124 study participants will be recruited, of which 62 participants will receive the Chance2Act intervention in addition to the usual care. The primary outcome is the changes in an individual?s readiness from a stage of not being ready to change (precontemplation, contemplation, or preparation stage) to being ready for weight loss (action stage). The secondary outcomes include changes in self-efficacy, decisional balance, family support for weight loss, BMI, waist circumference, and body fat composition. Results: The phase 1 study will reveal the intervention?s validity through the Content Validity Index and Face Validity Index, considering it valid if both indices exceed 0.83. The effectiveness of the intervention will be determined in phase 2, where the differences within and between groups will be analyzed in terms of the improvement of stages of change and all secondary outcomes as defined in the methodology. Data analysis for phase 2 will commence in 2024, with the anticipated publication of results in March 2024. Conclusions: If proven effective, the result of the study may give valuable insights into the effective behavioral modification strategies for a web-based intervention targeting adults with T2D with obesity but not yet ready to change for weight loss. This intervention may be replicated or adopted in different settings, focusing on behavioral modification support that patients need. This study offers a deeper understanding of the application of behavior change techniques for a more holistic approach to obesity care in T2D. Trial Registration: ClinicalTrials.gov NCT05736536; https://clinicaltrials.gov/study/NCT05736536 International Registered Report Identifier (IRRID): DERR1-10.2196/48313 UR - https://www.researchprotocols.org/2024/1/e48313 UR - http://dx.doi.org/10.2196/48313 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294848 ID - info:doi/10.2196/48313 ER - TY - JOUR AU - Lee, Seulki AU - Yuh, Chisung AU - Shin, Yu-Bin AU - Lee, Heon-Jeong AU - Lee, Young-Mee AU - Lee, Jungsil AU - Cho, Chul-Hyun PY - 2024/1/22 TI - Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial JO - J Med Internet Res SP - e51596 VL - 26 KW - video game KW - digital intervention KW - nature relatedness KW - nutritional status KW - psychological state KW - COVID-19 KW - urban-dwelling adults N2 - Background: During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being. Objective: Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being. Methods: A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life?Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient. Results: This study?s results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05). Conclusions: Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents? affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses. Trial Registration: Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7 UR - https://www.jmir.org/2024/1/e51596 UR - http://dx.doi.org/10.2196/51596 UR - http://www.ncbi.nlm.nih.gov/pubmed/38252464 ID - info:doi/10.2196/51596 ER - TY - JOUR AU - He, Yirong AU - Huang, Chuanya AU - He, Qiuyang AU - Liao, Shujuan AU - Luo, Biru PY - 2024/1/17 TI - Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis JO - JMIR Mhealth Uhealth SP - e49373 VL - 12 KW - mobile health KW - mHealth KW - lifestyle intervention KW - gestational diabetes mellitus KW - meta-analysis KW - mobile phone N2 - Background: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. Objective: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. Methods: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). Results: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=?1.12 kg, 95% CI ?1.44 to ?0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. Conclusions: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995 UR - https://mhealth.jmir.org/2024/1/e49373 UR - http://dx.doi.org/10.2196/49373 UR - http://www.ncbi.nlm.nih.gov/pubmed/38231555 ID - info:doi/10.2196/49373 ER - TY - JOUR AU - Shaw Jr, George AU - Castro, A. Bianca AU - Gunn, H. Laura AU - Norris, Keith AU - Thorpe Jr, J. Roland PY - 2024/1/10 TI - The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data JO - JMIR Mhealth Uhealth SP - e46656 VL - 12 KW - accessibility KW - eHealth literacy KW - mHealth KW - multivariable logistic regression KW - obesity KW - smartphones N2 - Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (?18 years of age) with obesity (BMI ?30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor?s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ?7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. UR - https://mhealth.jmir.org/2024/1/e46656 UR - http://dx.doi.org/10.2196/46656 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198196 ID - info:doi/10.2196/46656 ER - TY - JOUR AU - Myers, A. Candice AU - Beyl, A. Robbie AU - Hsia, S. Daniel AU - Harris, N. Melissa AU - Reed, J. Isabella AU - Eliser, D. Danielle AU - Bagneris, Lauren AU - Apolzan, W. John PY - 2023/12/20 TI - Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study JO - JMIR Res Protoc SP - e52193 VL - 12 KW - food security KW - body weight KW - racially minoritized group KW - low income KW - stress KW - cortisol KW - allostatic load N2 - Background: Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms. Objective: The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population?African American women. Methods: We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load. Results: This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023. Conclusions: We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations. Trial Registration: ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487 International Registered Report Identifier (IRRID): DERR1-10.2196/52193 UR - https://www.researchprotocols.org/2023/1/e52193 UR - http://dx.doi.org/10.2196/52193 UR - http://www.ncbi.nlm.nih.gov/pubmed/38117554 ID - info:doi/10.2196/52193 ER - TY - JOUR AU - Grady, Alice AU - Pearson, Nicole AU - Lamont, Hannah AU - Leigh, Lucy AU - Wolfenden, Luke AU - Barnes, Courtney AU - Wyse, Rebecca AU - Finch, Meghan AU - Mclaughlin, Matthew AU - Delaney, Tessa AU - Sutherland, Rachel AU - Hodder, Rebecca AU - Yoong, Lin Sze PY - 2023/12/19 TI - The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e47987 VL - 25 KW - engagement KW - digital health interventions KW - systematic review KW - nutrition KW - physical activity KW - obesity N2 - Background: Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs. Objective: This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes. Methods: The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the ?Synthesis Without Meta-Analysis? guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively. Results: Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size [ES]=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity?related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes. Conclusions: Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted. Trial Registration: PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333 UR - https://www.jmir.org/2023/1/e47987 UR - http://dx.doi.org/10.2196/47987 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113062 ID - info:doi/10.2196/47987 ER - TY - JOUR AU - Yau, Amy AU - Law, Cherry AU - Cornelsen, Laura AU - Adams, Jean AU - Boyland, Emma AU - Burgoine, Thomas AU - de Vocht, Frank AU - White, Martin AU - Cummins, Steven PY - 2023/12/19 TI - Association Between Household Online Grocery Delivery Service Use and Food and Drink Purchase Behavior in England: Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e41540 VL - 9 KW - food and beverages KW - food preferences KW - supermarkets KW - internet KW - consumer behavior KW - lifestyle KW - diet KW - inequality KW - food purchase KW - sociodemographic factors KW - grocery purchase KW - online grocery KW - online purchase KW - public health KW - online KW - delivery KW - grocery N2 - Background: Online grocery delivery services (OGDSs) are a popular way of acquiring food. However, it is unclear whether OGDS use is associated with the healthiness of purchases and whether there are sociodemographic differences in OGDS use. If so, the increased prevalence of OGDS use may have implications for population diet, and differential OGDS use could contribute to diet inequalities. Objective: This study aimed to examine whether OGDS use varies by sociodemographic characteristics and is associated with the amount and types of groceries purchased. Methods: Item-level take-home food and drink purchase data (n=3,233,920 items) from households in London and the North of England were available from the 2019 UK Kantar fast-moving consumer goods panel (N=1911). Purchases were categorized as being bought online or in-store. We used logistic regression to estimate the likelihood of an above-median frequency of OGDS use by sociodemographic characteristics. We used Poisson regression to estimate the differences in energy and nutrients purchased by households that had above- and below-median OGDS use and the proportion of energy purchased from products high in fat, salt, and sugar (HFSS) online versus in-store among households that used both shopping methods (n=665). Results: In total, 668 (35%) households used OGDSs at least once in 2019. Of the households that used OGDSs, the median use was 5 occasions in 2019. Households were more likely to have above-median use in London versus in the North of England (odds ratio 1.29, 95% CI 1.01-1.65) and if they had a higher annual household income (odds ratio 1.56, 95% CI 1.02-2.38 for ?£50,000 [US $64,000] vs <£20,000 [$25,600]). Households with above-median OGDS use had a higher weekly mean purchase of energy by 1461 (95% CI 1448-1474) kcal per person compared with households with below-median OGDS use. For households that used a combination of in-store and online shopping, HFSS products made up a lower proportion (?10.1%, 95% CI ?12% to ?8.1%) of energy purchased online compared to in-store. Conclusions: Differences in grocery purchases between households with above- and below-median OGDS use could have positive or negative consequences. The extra energy purchased among households with above-median OGDS use could lead to overconsumption or food waste, which has negative consequences for population and environmental health. Alternatively, this extra energy may be replacing out-of-home purchasing, which tends to be less healthy, and may be beneficial for the population diet. Households made fewer HFSS purchases when shopping online compared to in-store, which may be due to differences in the shopping environment or experience, such as fewer promotions and advertisements when shopping online or not having to transport and carry purchases home. As higher-income households used OGDS more frequently, the implications of this sociodemographic pattern on dietary inequalities must be explored. UR - https://publichealth.jmir.org/2023/1/e41540 UR - http://dx.doi.org/10.2196/41540 UR - http://www.ncbi.nlm.nih.gov/pubmed/38113090 ID - info:doi/10.2196/41540 ER - TY - JOUR AU - Chen, Dandan AU - Zhang, Hui AU - Wu, Jingjie AU - Xue, Erxu AU - Guo, Pingping AU - Tang, Leiwen AU - Shao, Jing AU - Cui, Nianqi AU - Wang, Xiyi AU - Chen, Liying AU - Ye, Zhihong PY - 2023/11/29 TI - Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study JO - J Med Internet Res SP - e49257 VL - 25 KW - metabolic syndrome KW - health behavior KW - cardiovascular risk KW - mobile health KW - behavior change wheel N2 - Background: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)?based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. Objective: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. Methods: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). Results: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. Conclusions: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs. UR - https://www.jmir.org/2023/1/e49257 UR - http://dx.doi.org/10.2196/49257 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019579 ID - info:doi/10.2196/49257 ER - TY - JOUR AU - Lei, Ting AU - Li, Mingqing AU - Qian, Hu AU - Yang, Junxiao AU - Hu, Yihe AU - Hua, Long PY - 2023/11/7 TI - The Effect of Sleep on Metabolism, Musculoskeletal Disease, and Mortality in the General US Population: Analysis of Results From the National Health and Nutrition Examination Survey JO - JMIR Public Health Surveill SP - e46385 VL - 9 KW - sleep duration KW - mortality KW - clinical outcomes KW - threshold effect KW - National Health and Nutrition Examination Survey N2 - Background: Sleep is an important physiological behavior in humans that is associated with the occurrence and development of various diseases. However, the association of sleep duration with health-related outcomes, including obesity-related factors, musculoskeletal diseases, and mortality because of different causes, has not been systematically reported. Objective: This study aims to systematically investigate the effect of sleep duration on health-related outcomes. Methods: Overall, 54,664 participants with sleep information from 8 survey cycles of the National Health and Nutrition Examination Survey (2005-2020) were included in the analysis. Health-related outcomes comprised obesity-related outcomes (ie, BMI, obesity, waist circumference, and abdominal obesity), metabolism-related outcomes (ie, uric acid, hyperuricemia, and bone mineral density [BMD]), musculoskeletal diseases (ie, osteoarthritis [OA] and rheumatoid arthritis [RA]), and mortality because of different causes. The baseline information of participants including age, sex, race, educational level, marital status, total energy intake, physical activity, alcohol consumption, smoking, hypertension, and diabetes was also collected as covariates. Information about the metabolism index, disease status, and covariates was acquired from the laboratory, examination, and questionnaire data. Survival information, including survival status, duration, and cause of death, was obtained from the National Death Index records. Quantile regression models and Cox regression models were used for association analysis between sleep duration and health-related outcomes. In addition, the threshold effect analysis, along with smooth curve fitting method, was applied for the nonlinear association analysis. Results: Participants were divided into 4 groups with different sleep durations. The 4 groups showed significant differences in terms of baseline data (P<.001). The quantile regression analysis indicated that participants with increased sleep duration showed decreased BMI (?=?.176, 95% CI ?.220 to ?.133; P<.001), obesity (odds ratio [OR] 0.964, 95% CI 0.950-0.977; P<.001), waist circumference (?=?.219, 95% CI ?.320 to ?.117; P<.001), abdominal obesity (OR 0.975, 95% CI 0.960-0.990; P<.001), OA (OR 0.965, 95% CI 0.942-0.990; P=.005), and RA (OR 0.940, 95% CI 0.912-0.968; P<.001). Participants with increased sleep duration also showed increased BMD (?=.002, 95% CI .001-.003; P=.005), as compared with participants who slept <5.5 hours. A significant saturation effect of sleep duration on obesity, abdominal obesity, and hyperuricemia was detected through smooth curve fitting and threshold effect analysis (sleep duration>inflection point). In addition, a significant threshold effect of sleep duration on BMD (P<.001); OA (P<.001); RA (P<.001); and all-cause (P<.001), cardiovascular disease?cause (P<.001), cancer-cause (P=.005), and diabetes-cause mortality (P<.001) was found. The inflection point was between 6.5 hours and 9 hours. Conclusions: The double-edged sword effect of sleep duration on obesity-related outcomes, embolism-related diseases, musculoskeletal diseases, and mortality because of different causes was detected in this study. These findings provided epidemiological evidence that proper sleep duration may be an important factor in the prevention of multisystem diseases. UR - https://publichealth.jmir.org/2023/1/e46385 UR - http://dx.doi.org/10.2196/46385 UR - http://www.ncbi.nlm.nih.gov/pubmed/37934562 ID - info:doi/10.2196/46385 ER - TY - JOUR AU - Berry, Michael AU - Taylor, Lauren AU - Huang, Zhuoran AU - Chwyl, Christina AU - Kerrigan, Stephanie AU - Forman, Evan PY - 2023/11/6 TI - Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study JO - JMIR Form Res SP - e50872 VL - 7 KW - mobile health technology KW - weight loss KW - tailored messaging KW - lifestyle modification KW - mobile health KW - mHealth KW - messaging KW - intervention KW - overweight KW - obesity KW - qualitative KW - thematic analysis N2 - Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users? subjective experiences while receiving automated messaging?based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 UR - https://formative.jmir.org/2023/1/e50872 UR - http://dx.doi.org/10.2196/50872 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930786 ID - info:doi/10.2196/50872 ER - TY - JOUR AU - Bond, S. Dale AU - Papasavas, K. Pavlos AU - Raynor, A. Hollie AU - Grilo, M. Carlos AU - Steele, R. Vaughn PY - 2023/11/6 TI - Transcranial Magnetic Stimulation for Reducing the Relative Reinforcing Value of Food in Adult Patients With Obesity Pursuing Metabolic and Bariatric Surgery: Protocol for a Pilot, Within-Participants, Sham-Controlled Trial JO - JMIR Res Protoc SP - e50714 VL - 12 KW - obesity KW - repetitive transcranial magnetic stimulation KW - food reinforcement KW - hedonic hunger KW - electroencephalography KW - metabolic and bariatric surgery N2 - Background: Metabolic and bariatric surgery (MBS) is the most effective and durable obesity treatment. However, there is heterogeneity in weight outcomes, which is partially attributed to variability in appetite and eating regulation. Patients with a strong desire to eat in response to the reward of palatable foods are more likely to overeat and experience suboptimal outcomes. This subgroup, classified as at risk, may benefit from repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique that shows promise for reducing cravings and consumption of addictive drugs and food; no study has evaluated how rTMS affects the reinforcing value of food and brain reward processing in the context of MBS. Objective: The goal of the Transcranial Magnetic Stimulation to Reduce the Relative Reinforcing Value of Food (RESTRAIN) study is to perform an initial rTMS test on the relative reinforcing value (RRV) of food (the reinforcing value of palatable food compared with money) among adult patients who are pursuing MBS and report high food reinforcement. Using a within-participants sham-controlled crossover design, we will compare the active and sham rTMS conditions on pre- to posttest changes in the RRV of food (primary objective) and the neural modulation of reward, measured via electroencephalography (EEG; secondary objective). We hypothesize that participants will show larger decreases in food reinforcement and increases in brain reward processing after active versus sham rTMS. Methods: Participants (n=10) will attend 2 study sessions separated by a washout period. They will be randomized to active rTMS on 1 day and sham rTMS on the other day using a counterbalanced schedule. For both sessions, participants will arrive fasted in the morning and consume a standardized breakfast before being assessed on the RRV of food and reward tasks via EEG before and after rTMS of the left dorsolateral prefrontal cortex. Results: Recruitment and data collection began in December 2022. As of October 2023, overall, 52 patients have been screened; 36 (69%) screened eligible, and 17 (47%) were enrolled. Of these 17 patients, 3 (18%) were excluded before rTMS, 5 (29%) withdrew, 4 (24%) are in the process of completing the protocol, and 5 (29%) completed the protocol. Conclusions: The RESTRAIN study is the first to test whether rTMS can target neural reward circuits to reduce behavioral (RRV) and neural (EEG) measures of food reward in patients who are pursuing MBS. If successful, the results would provide a rationale for a fully powered trial to examine whether rTMS-related changes in food reinforcement translate into healthier eating patterns and improved MBS outcomes. If the results do not support our hypotheses, we will continue this line of research to evaluate whether additional rTMS sessions and pulses as well as different stimulation locations produce clinically meaningful changes in food reinforcement. Trial Registration: ClinicalTrials.gov NCT05522803; https://clinicaltrials.gov/study/NCT05522803 International Registered Report Identifier (IRRID): DERR1-10.2196/50714 UR - https://www.researchprotocols.org/2023/1/e50714 UR - http://dx.doi.org/10.2196/50714 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930756 ID - info:doi/10.2196/50714 ER - TY - JOUR AU - Wang, Xijie AU - Dong, Bin AU - Huang, Feifei AU - Zhang, Ji AU - He, Rongxin AU - Du, Shufa AU - Zhang, Jiguo AU - Ma, Jun AU - Wang, Huijun AU - Zhang, Bing AU - Liang, Wannian PY - 2023/10/23 TI - Temporal Trends in Cardiovascular Health Status Among Chinese School-Aged Children From 1989 to 2018: Multiwave Cross-Sectional Analysis JO - JMIR Public Health Surveill SP - e45564 VL - 9 KW - cardiovascular health KW - school-aged children KW - temporal change KW - China Health and Nutrition Survey N2 - Background: Despite the release of updated metrics for Life?s Essential 8 (LE8), key indicators for assessing cardiovascular health (CVH) status, there is currently no report on their distribution among Chinese children. Objective: This study aimed to assess the nationwide distribution of CVH in Chinese school-aged children using LE8 scores and analyze temporal changes in these scores over time. Methods: Participants aged 7 to 19 years from 11 waves (between 1989 and 2018) of the China Health and Nutrition Survey were included in this study. LE8 components were grouped into 2 domains of health behaviors (diet, physical activity, nicotine exposure, sleep) and health factors (BMI, blood lipids, blood glucose, blood pressure). Scores of overall CVH and each LE8 metric were calculated individually. Temporal changes were assessed with joint point regression models by rural and urban living residence. The causal relationships between health behaviors and health factors that changed the most over time were built with cross-lagged panel models. Results: A total of 21,921 participants, 52.6% (n=11,537) of whom were male, who had data for at least 4 CVH components were included in the analysis. The mean age was 13 (SD 3.6) years. The overall CVH score remained stable in most regions, with the lowest found in Shandong from East China, which had a mean between 67 (SD 10.9) and 67.2 (SD 12.4). In contrast, the highest score was found in Guizhou from Southwest China, with a mean between 71.4 (SD 10.8) and 74.3 (SD 10.3). In rural areas, the diet score decreased significantly from 1997 onward with a speed of 0.18 (95% CI: 0.15-0.21; P<.001) per year, and the BMI score decreased significantly from 2005 onward with a speed of 0.56 (95% CI 0.44-0.68; P<.001) per year. In urban areas, the diet score decreased from 1994 onward with a speed of 0.03 (95% CI: 0.001-0.07; P=.04) per year, and the BMI score decreased from 2002 onward with a speed of 0.63 (95% CI 0.47-0.79; P<.001) per year. The sleep score dropped constantly in both urban and rural areas, with a speed of 0.69 (95% CI 0.58-0.80; P<.001) and 0.69 (95% CI: 0.52-0.86; P<.001) per year, respectively. A decline in the diet score led to a decline in the BMI score with a coefficient of 0.190 (95% CI 0.030-0.351; P=.02), while a decline in the BMI score led to a decline in sleep health with a coefficient of 0.089 (95% CI 0.010-0.168; P=.03). Conclusions: Chinese school-aged children and adolescents were generally of moderate CVH status, but mutual influences existed between CVH metrics. Dietary interventions should be prioritized for promoting overall CVH in the future. UR - https://publichealth.jmir.org/2023/1/e45564 UR - http://dx.doi.org/10.2196/45564 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870895 ID - info:doi/10.2196/45564 ER - TY - JOUR AU - Matsumoto, Shinya AU - Kanagawa, Yoshiyuki AU - Nagoshi, Kiwamu AU - Akahane, Takemi AU - Imamura, Tomoaki AU - Akahane, Manabu PY - 2023/10/23 TI - Consumer Willingness to Pay for Food Defense and Food Hygiene in Japan: Cross-Sectional Study JO - Interact J Med Res SP - e43936 VL - 12 KW - food defense KW - food hygiene KW - contingent valuation method KW - willingness KW - food KW - cost KW - awareness KW - food safety KW - questionnaire KW - Japan KW - prevention KW - food poisoning KW - safety N2 - Background: In Japan, incidents of falsified expiration dates on popular cookie brands and health hazards associated with frozen Chinese dumplings have raised food safety awareness. To prevent the intentional contamination of food by foreign substances, large food manufacturing companies have adopted the concept of food defense. Objective: The aim of this study was to assess people?s willingness to pay for food protection measures. In addition, the impact of participants? personalities and considerations regarding their purchase choices on how much they were willing to pay when shopping for food and other products were measured. Methods: A questionnaire on willingness to pay for food hygiene and food defense was administered via a web survey and 1414 responses were included in the analysis. Univariate logistic regression analyses were performed with individuals willing and unwilling to pay additional costs as the objective variable and other questionnaire items as explanatory variables. A principal component analysis was performed on 12 questions regarding how much additional money people were willing to pay, and the principal component scores and other questions were examined for implications and other information. Results: Approximately one-third of the respondents stated that they were unwilling to pay additional costs and reported a willingness to consume delivery food even if it contained items that were not part of the original order. The first principal component reflected the extent to which people were willing to pay additional money, and if so, how much. This tendency existed even if the individual foods and amounts varied. The third principal component reflected the amount of extra money that people were willing to pay, which was determined by the amount people had to pay toward food safety measures. Those who answered ?zero? were more likely to believe that consumers should not have to pay to ensure food safety. The second principal component reflected an axis separating food defense and food hygiene. Some items not directly related to food were correlated with this axis. Conclusions: In Japan, the concept of food hygiene is well-established and is generally taken for granted. In contrast, the concept of food defense is relatively new and has not yet fully penetrated the Japanese market. Our research shows that people who think that clothing brands provided added value to clothing products may have similar feelings about food defense. In addition, food hygiene efforts to prevent outbreaks of food poisoning are common in Japan and have been established as the basis of food safety. While food defense efforts are spreading, mainly in companies, it is presumed that they are valuable for the general public as supplementary measures to routine (or basic) food hygiene. UR - https://www.i-jmr.org/2023/1/e43936 UR - http://dx.doi.org/10.2196/43936 UR - http://www.ncbi.nlm.nih.gov/pubmed/37870896 ID - info:doi/10.2196/43936 ER - TY - JOUR AU - Pogrebnoy, Dina AU - Dennett, M. Amy AU - Simpson, B. Dawn AU - MacDonald-Wicks, Lesley AU - Patterson, J. Amanda AU - English, Coralie PY - 2023/10/19 TI - Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e49357 VL - 25 KW - modifiable risk factors KW - secondary prevention KW - physical activity KW - diet quality KW - websites KW - chronic health KW - chronic illness N2 - Background: Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. Objective: The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. Methods: Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. Results: A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. Conclusions: The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. Trial Registration: PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168 UR - https://www.jmir.org/2023/1/e49357 UR - http://dx.doi.org/10.2196/49357 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856187 ID - info:doi/10.2196/49357 ER - TY - JOUR AU - Bucher Della Torre, Sophie AU - Lages, Marlene AU - Dias, S. Sara AU - Guarino, P. Maria AU - Braga-Pontes, Cátia PY - 2023/10/3 TI - Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study JO - JMIR Serious Games SP - e43843 VL - 11 KW - vegetable KW - food preference KW - serious games KW - video game KW - children KW - child KW - pediatric KW - obesity prevention KW - pilot study KW - gaming KW - educational game KW - nutrition KW - diet KW - healthy eating KW - food consumption KW - food intake N2 - Background: Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake. Objective: This pilot study aimed first to translate the digital game ?Veggies4myHeart? into French and to assess its influence on young children?s preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms. Methods: During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview. Results: A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children?s declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools. Conclusions: In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake. UR - https://games.jmir.org/2023/1/e43843 UR - http://dx.doi.org/10.2196/43843 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788064 ID - info:doi/10.2196/43843 ER - TY - JOUR AU - Brunet, Jennifer AU - Sharma, Sitara AU - Price, Jenson AU - Black, Melissa PY - 2023/10/3 TI - Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial JO - JMIR Form Res SP - e48301 VL - 7 KW - behavior change KW - motivation KW - overweight KW - obese KW - physical activity KW - women KW - digital KW - randomized trial KW - mobile phone N2 - Background: Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)?driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese. Objective: This substudy explores users? perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations. Methods: A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ?25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively. Results: The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was ?enjoyable? and ?helpful?; quantitative data corroborated this, as 71% (10/14) said that the monitor was ?very valuable/absolutely valuable,? 71% (10/14) would ?very probably/definitely? still use one, and 86% (12/14) wore it for ?5 days per week for ?8 hours per day and checked it ?occasionally/frequently/very frequently.? Potential threats to acceptability included ?long? and ?text-heavy? emails; lack of personal contact; and cumbersome, unaesthetic monitors. Conclusions: Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 International Registered Report Identifier (IRRID): RR2-10.1177/20552076221093134 UR - https://formative.jmir.org/2023/1/e48301 UR - http://dx.doi.org/10.2196/48301 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788048 ID - info:doi/10.2196/48301 ER - TY - JOUR AU - Katena, Arster Nyaradzai AU - Shamu, Shepherd AU - Fana, Tafadzwa Golden AU - Rusakaniko, Simbarashe PY - 2023/10/3 TI - Effects of a Community Health Worker?Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial JO - JMIR Res Protoc SP - e47512 VL - 12 KW - hypertension KW - diabetes KW - community health worker KW - lifestyle modification KW - cluster randomized controlled trial KW - protocol KW - Harare KW - Zimbabwe KW - RCT KW - randomized controlled trial KW - hypertensive KW - blood pressure KW - CHW KW - diabetic KW - Africa KW - healthy lifestyle KW - health literacy N2 - Background: Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. Objective: This study aims to evaluate the effects of a community health worker (CHW)?led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. Methods: This is a 6-month?long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. Results: Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants? recruitment, and the final data collection will be completed by January 31, 2024. Conclusions: There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. International Registered Report Identifier (IRRID): PRR1-10.2196/47512 UR - https://www.researchprotocols.org/2023/1/e47512 UR - http://dx.doi.org/10.2196/47512 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788044 ID - info:doi/10.2196/47512 ER - TY - JOUR AU - Sun, Shufang AU - Nardi, William AU - Murphy, Matthew AU - Scott, Ty AU - Saadeh, Frances AU - Roy, Alexandra AU - Brewer, Judson PY - 2023/9/26 TI - Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial JO - J Med Internet Res SP - e46310 VL - 25 KW - mobile health KW - mindfulness KW - obesity KW - sexual minority women KW - early life adversity KW - cell phone KW - mobile phone N2 - Background: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. Objective: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ?25 kg/m2) to improve health outcomes. Methods: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. Results: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. Conclusions: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women. UR - https://www.jmir.org/2023/1/e46310 UR - http://dx.doi.org/10.2196/46310 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751273 ID - info:doi/10.2196/46310 ER - TY - JOUR AU - Okemah, Jennifer AU - Neunie, Sola AU - Noble, Alexander AU - Wysham, Carol PY - 2023/9/13 TI - Impact on Knowledge, Competence, and Performance of a Faculty-Led Web-Based Educational Activity for Type 2 Diabetes and Obesity: Questionnaire Study Among Health Care Professionals and Analysis of Anonymized Patient Records JO - JMIR Form Res SP - e49115 VL - 7 KW - continuing medical education KW - incretin-based therapy KW - multidisciplinary care KW - obesity KW - overweight KW - type 2 diabetes KW - patient data KW - diabetes management KW - patient education KW - chronic disease KW - web-based education KW - digital education KW - health education KW - diabetes KW - diabetes mellitus KW - survey KW - web-based survey KW - education KW - glycemic N2 - Background: Strategies for managing type 2 diabetes (T2D) and obesity are evolving with the introduction of targeted therapies, including incretin-based dual agonists and growing knowledge of the importance of multidisciplinary care. Accessible, effective continuing medical education (CME) activities are required to ensure that health care professionals (HCPs) understand and can implement the most recent data to optimize patient outcomes. Objective: We aimed to measure changes in knowledge, competence, and self-reported performance and quantitatively evaluate changes in performance using anonymized patient data following participation in a web-based educational activity. The faculty-led CME-accredited activity was based on incretin-based dual agonists and patient education on T2D and obesity. The remaining educational gaps in this field were also identified. Methods: A CME-accredited, web-based, multidisciplinary (touchMDT) educational activity titled ?The future for glycemic control and weight loss in T2D and obesity: Incretin-based dual-agonists and optimizing patient education? was developed. HCP knowledge, competence, and performance were assessed before and after the activity against Moore?s expanded outcomes framework (levels 1-5), using self-reported questionnaires and by analyzing anonymized patient record data. Results: For evaluating knowledge and competence (50 respondents before and 50 learners after the activity), the mean number of correctly answered questions was significantly higher post activity (median 5.0, IQR 4.0-6.0 to 6.0, IQR 5.0-7.0; mean 4.98, SD 1.22 to 5.78, SD 1.13; P<.001). Modest, nonsignificant improvements in self-reported performance (N=50 respondents preactivity; N=50 learners postactivity) from before to after the activity were observed (median 4.0, IQR 3.25-4.0 to 4.0, IQR 4.0-4.0; mean 3.64, SD 0.69 to 3.76, SD 0.48; P=.32). PPatient data analysis indicated that patients were being treated more intensively postactivity: before the activity, the most commonly used treatment regimens were metformin monotherapy (13/50, 26%) and dual therapy with metformin plus injectable glucagon-like peptide-1 (GLP-1) receptor agonist (RA; 11/50, 22%); post activity, this changed to dual therapy with metformin plus injectable GLP-1 RA (12/50, 24%) and triple therapy with metformin plus injectable GLP-1 RA plus sodium-glucose cotransporter-2 inhibitor (SGLT2i; 10/50, 20%). In addition, there was an increased number of referrals to a combination of specialists (physicians referred 27%, 8/30 of patients to ?2 specialists before the activity and 36%, 10/28 to ?2 specialists post activity). The remaining educational gaps included understanding the biology and psychology of obesity, efficacy and safety data for incretin-based dual agonists, and the role of the diabetes educator or diabetes care and education specialist in managing T2D and obesity. Conclusions: This short, web-based CME activity on the management of T2D and obesity led to improvements in HCP knowledge, competence, and performance. Several remaining unmet needs were identified, which can be used to inform the content of future educational activities in this disease area. UR - https://formative.jmir.org/2023/1/e49115 UR - http://dx.doi.org/10.2196/49115 UR - http://www.ncbi.nlm.nih.gov/pubmed/37703084 ID - info:doi/10.2196/49115 ER - TY - JOUR AU - Ganie, Ashraf Mohd AU - Chowdhury, Subhankar AU - Suri, Vanita AU - Joshi, Beena AU - Bhattacharya, Kumar Prasanta AU - Agrawal, Sarita AU - Malhotra, Neena AU - Sahay, Rakesh AU - Jabbar, Khadar Puthiyaveettil AU - Rozati, Roya AU - Wani, Ahmad Imtiyaz AU - Shukla, Amlin AU - Arora, Taruna AU - Rashid, Haroon PY - 2023/9/6 TI - Prevalence, Regional Variations, and Predictors of Overweight, Obesity, and Hypertension Among Healthy Reproductive-Age Indian Women: Nationwide Cross-Sectional Polycystic Ovary Syndrome Task Force Study JO - JMIR Public Health Surveill SP - e43199 VL - 9 KW - Indian Council of Medical Research?polycystic ovary syndrome study KW - ICMR-PCOS study KW - noncommunicable diseases KW - disease surveillance KW - obesity KW - hypertension KW - anthropometry KW - healthy reproductive-age women KW - socioeconomic status N2 - Background: A clear understanding of the anthropometric and sociodemographic risk factors related to BMI and hypertension categories is essential for more effective disease prevention, particularly in India. There is a paucity of nationally representative data on the dynamics of these risk factors, which have not been assessed among healthy reproductive-age Indian women. Objective: This cross-sectional polycystic ovary syndrome (PCOS) task force study aimed to assess the anthropometric and sociodemographic characteristics of healthy reproductive-age Indian women and explore the association of these characteristics with various noncommunicable diseases. Methods: We conducted a nationwide cross-sectional survey from 2018 to 2022 as part of the Indian Council of Medical Research?PCOS National Task Force study, with the primary aim of estimating the national prevalence of PCOS and regional phenotypic variations among women with PCOS. A multistage random sampling technique was adopted, and 7107 healthy women (aged 18-40 years) from 6 representative geographical zones of India were included in the study. The anthropometric indices and sociodemographic characteristics of these women were analyzed. Statistical analysis was performed to assess the association between exposure and outcome variables. Results: Of the 7107 study participants, 3585 (50.44%) were from rural areas and 3522 (49.56%) were from urban areas. The prevalence of obesity increased from 8.1% using World Health Organization criteria to 40% using the revised consensus guidelines for Asian Indian populations. Women from urban areas showed higher proportions of overweight (524/1908, 27.46%), obesity (775/1908, 40.62%), and prehypertension (1008/1908, 52.83%) categories. A rising trend of obesity was observed with an increase in age. Women aged 18 to 23 years were healthy (314/724, 43.4%) and overweight (140/724, 19.3%) compared with women aged 36 to 40 years with obesity (448/911, 49.2%) and overweight (216/911, 23.7%). The proportion of obesity was high among South Indian women, with 49.53% (531/1072) and 66.14% (709/1072), using both World Health Organization criteria and the revised Indian guidelines for BMI, respectively. BMI with waist circumference and waist-to-height ratio had a statistically significant linear relationship (r=0.417; P<.001 and r=0.422; P<.001, respectively). However, the magnitude, or strength, of the association was relatively weak (0.3<|r|<0.5). Statistical analysis showed that the strongest predictors of being overweight or obese were older age, level of education, wealth quintile, and area of residence. Conclusions: Anthropometric and sociodemographic characteristics are useful predictors of overweight- and obesity-related syndromes, including prehypertension, among healthy Indian women. Increased attention to the health of Indian women from public health experts and policy makers is warranted. The findings of this study can be leveraged to offer valuable insights, informing health decision-making and targeted interventions that mitigate risk factors of overweight, obesity, and hypertension. International Registered Report Identifier (IRRID): RR2-10.2196/23437 UR - https://publichealth.jmir.org/2023/1/e43199 UR - http://dx.doi.org/10.2196/43199 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672315 ID - info:doi/10.2196/43199 ER - TY - JOUR AU - Li, Wenzhen AU - Chen, Dajie AU - Peng, Ying AU - Lu, Zuxun AU - Kwan, Mei-Po AU - Tse, Ah Lap PY - 2023/9/5 TI - Association Between Metabolic Syndrome and Mortality: Prospective Cohort Study JO - JMIR Public Health Surveill SP - e44073 VL - 9 KW - metabolic syndrome KW - mortality KW - heart disease KW - diabetes mellitus KW - cancer N2 - Background: Metabolic syndrome (MetS) is a common metabolic disorder that results from the increasing prevalence of obesity, which has been an increasing concern in recent years. Previous evidence indicated that MetS was associated with mortality; however, different definitions of MetS were used. In 2005, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III updated the definition of MetS, which has since been widely adopted. Therefore, it is necessary to conduct a novel study among other populations and countries with a larger sample size using the updated definition of MetS and death code to examine the association of MetS with all-cause and cause-specific mortality. Objective: We aimed to examine the associations of MetS with all-cause and cause-specific mortality. Methods: A total of 36,414 adults were included in this study, using data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the continuous NHANES (1999-2014) in the United States. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2015. MetS was defined by the NCEP ATP III-2005 criterion. Complex survey design factors including sample weights, clustering, and stratification were considered for all analyses with instructions for using NHANES data. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for mortality from all causes, heart disease, diabetes, and cancer. Results: We observed 8494 deaths during the 16.71 years of follow-up. Compared with those without MetS, individuals with MetS were associated with a significantly elevated multiadjusted HR of 1.24 (95% CI 1.16-1.33), 1.44 (95% CI 1.25-1.66), and 5.15 (95% CI 3.15-8.43) for all cause, heart diseases, and diabetes mellitus, respectively, whereas no significant association was found for cancer mortality (HR 1.17, 95% CI 0.95-1.43). Conclusions: Our study provides additional evidence that MetS and its components are significantly associated with all-cause, heart disease, and diabetes mortality, but not with cancer mortality. Health care professionals should pay more attention to MetS and its individual component. UR - https://publichealth.jmir.org/2023/1/e44073 UR - http://dx.doi.org/10.2196/44073 UR - http://www.ncbi.nlm.nih.gov/pubmed/37669100 ID - info:doi/10.2196/44073 ER - TY - JOUR AU - Pagoto, Sherry AU - Xu, Ran AU - Bullard, Tiffany AU - Foster, D. Gary AU - Bannor, Richard AU - Arcangel, Kaylei AU - DiVito, Joseph AU - Schroeder, Matthew AU - Cardel, I. Michelle PY - 2023/8/29 TI - An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial JO - J Med Internet Res SP - e44955 VL - 25 KW - weight loss KW - digital behavioral weight management program KW - single-arm behavioral trial KW - personalized weight loss program KW - ZeroPoint foods KW - weight management KW - digital intervention KW - diet management KW - exercise N2 - Background: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. Objective: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ?300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. Methods: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. Results: Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants? mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of ?4.25% (SD 3.93%) from baseline to 3 months and ?5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ?3%, ?5%, and ?10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ?1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). Conclusions: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability. UR - https://www.jmir.org/2023/1/e44955 UR - http://dx.doi.org/10.2196/44955 UR - http://www.ncbi.nlm.nih.gov/pubmed/37642986 ID - info:doi/10.2196/44955 ER - TY - JOUR AU - Mitchell, Siobhan Ellen AU - Fabry, Alexander AU - Ho, Suh Annabell AU - May, N. Christine AU - Baldwin, Matthew AU - Blanco, Paige AU - Smith, Kyle AU - Michaelides, Andreas AU - Shokoohi, Mostafa AU - West, Michael AU - Gotera, Kim AU - El Massad, Omnya AU - Zhou, Anna PY - 2023/8/24 TI - The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study JO - JMIR Mhealth Uhealth SP - e47473 VL - 11 KW - mobile health KW - mHealth KW - obesity KW - overweight KW - Noom Weight KW - digital weight loss intervention KW - health care resource utilization KW - costs KW - electronic health record KW - EHR KW - insurance claims KW - inverse probability of treatment weighting KW - IPTW KW - mobile phone N2 - Background: The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. Objective: This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. Methods: Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non?Noom Weight users aged between 18 and 80 years with a BMI of ?25 kg/m² and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. Results: Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] ?US $20.10, 95% CI ?US $30.08 to ?US $10.12), less outpatient costs (MD ?US $124.33, 95% CI ?US $159.76 to ?US $88.89), less overall prescription costs (MD ?US $313.82, 95% CI ?US $565.42 to ?US $62.21), and less overall health care costs (MD ?US $450.39, 95% CI ?US $706.28 to ?US $194.50) per user than non?Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD ?0.03, 95% CI ?0.04 to ?0.03), fewer outpatient visits (MD ?0.78, 95% CI ?0.93 to ?0.62), fewer surgeries (MD ?0.01, 95% CI ?0.01 to 0.00), and fewer prescriptions (MD ?1.39, 95% CI ?1.76 to ?1.03) per user than non?Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD ?US $1139.52, 95% CI ?US $1972.21 to ?US $306.83) and lower overall health care costs (MD ?US $1219.06, 95% CI ?US $2061.56 to ?US $376.55) per user than non?Noom Weight users. The key differences were associated with reduced prescription use. Conclusions: Noom Weight use is associated with lower HRU and costs than non?Noom Weight use, with potential cost savings of up to US $1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight. UR - https://mhealth.jmir.org/2023/1/e47473 UR - http://dx.doi.org/10.2196/47473 UR - http://www.ncbi.nlm.nih.gov/pubmed/37616049 ID - info:doi/10.2196/47473 ER - TY - JOUR AU - Woo, Sarah AU - Jung, Sunho AU - Lim, Hyunjung AU - Kim, YoonMyung AU - Park, Hee Kyung PY - 2023/8/17 TI - Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study JO - J Med Internet Res SP - e45407 VL - 25 KW - behavioral dynamics KW - behavioral phenotype KW - functional data analysis KW - FDA KW - machine learning analysis KW - mobile health KW - mHealth KW - obesity intervention KW - pediatric obesity KW - mobile phone N2 - Background: Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes. Objective: This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach. Methods: In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ?85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change. Results: Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (?=?.0766, 95% CI ?.1245 to ?.0312), fruit and vegetable intake (?=.1770, 95% CI .0642-.2561), exercise (?=?.0711, 95% CI ?.0892 to ?.0363), drinking water (?=?.0203, 95% CI ?.0218 to ?.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (?=.0440, 95% CI .0186-.0550), fruit and vegetable intake (?=?.1177, 95% CI ?.1441 to ?.0680), and sleep duration (?=?.0991, 95% CI ?.1254 to ?.0597). Conclusions: Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention. Trial Registration: Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay UR - https://www.jmir.org/2023/1/e45407 UR - http://dx.doi.org/10.2196/45407 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590040 ID - info:doi/10.2196/45407 ER - TY - JOUR AU - Ruf, Alea AU - Neubauer, B. Andreas AU - Koch, D. Elena AU - Ebner-Priemer, Ulrich AU - Reif, Andreas AU - Matura, Silke PY - 2023/8/17 TI - Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry JO - JMIR Ment Health SP - e46550 VL - 10 KW - impulsivity KW - nutrition KW - macronutrient intake KW - physical activity KW - ecological momentary assessment KW - EMA KW - attention-deficit/hyperactivity disorder KW - ADHD KW - diet KW - neurodevelopmental KW - hyperactivity KW - macronutrient KW - psychiatry KW - symptoms KW - mobile KW - mobile phone N2 - Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: ?=?.09, 95% CI ?0.14 to ?0.04; control: ?=?.03, 95% CI ?0.05 to ?0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. UR - https://mental.jmir.org/2023/1/e46550 UR - http://dx.doi.org/10.2196/46550 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590053 ID - info:doi/10.2196/46550 ER - TY - JOUR AU - Pigat, Sandrine AU - Soshina, Mariya AU - Berezhnaya, Yulia AU - Kryzhanovskaya, Ekaterina PY - 2023/8/16 TI - Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study JO - JMIR Form Res SP - e41774 VL - 7 KW - dietary assessment KW - 24-hour dietary recall KW - extent of agreement KW - energy and nutrient intake KW - Russian diet KW - interviewer-administered KW - web-based self-administered KW - diet KW - food intake KW - dietary recall KW - energy intake KW - nutrient intake N2 - Background: Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used. Objective: The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool. Methods: This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed. Results: In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4% and 90.5% of data points were within the limits of agreement among all age groups and nutrients analyzed. A ?moderate to excellent? reliability between the 2 methods was observed in younger children. In older children, a ?moderate to good? reliability was observed, with the exception of sodium. In adults, ?moderate to excellent? reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ?50%, and the percentages of participants categorized into the opposite tertile of intake were <10%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool. Conclusions: Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children. Trial Registration: ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160 UR - https://formative.jmir.org/2023/1/e41774 UR - http://dx.doi.org/10.2196/41774 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585243 ID - info:doi/10.2196/41774 ER - TY - JOUR AU - Glympi, Alkyoni AU - Odegi, Dorothy AU - Zandian, Modjtaba AU - Södersten, Per AU - Bergh, Cecilia AU - Langlet, Billy PY - 2023/8/10 TI - Eating Behavior and Satiety With Virtual Reality Meals Compared With Real Meals: Randomized Crossover Study JO - JMIR Serious Games SP - e44348 VL - 11 KW - exposure therapy KW - eating behavior KW - anorexia nervosa KW - bulimia nervosa KW - binge eating disorder KW - overweight KW - obesity KW - immersive virtual reality KW - VR KW - virtual reality N2 - Background: Eating disorders and obesity are serious health problems with poor treatment outcomes and high relapse rates despite well-established treatments. Several studies have suggested that virtual reality technology could enhance the current treatment outcomes and could be used as an adjunctive tool in their treatment. Objective: This study aims to investigate the differences between eating virtual and real-life meals and test the hypothesis that eating a virtual meal can reduce hunger among healthy women. Methods: The study included 20 healthy women and used a randomized crossover design. The participants were asked to eat 1 introduction meal, 2 real meals, and 2 virtual meals, all containing real or virtual meatballs and potatoes. The real meals were eaten on a plate that had been placed on a scale that communicated with analytical software on a computer. The virtual meals were eaten in a room where participants were seated on a real chair in front of a real table and fitted with the virtual reality equipment. The eating behavior for both the real and virtual meals was filmed. Hunger was measured before and after the meals using questionnaires. Results: There was a significant difference in hunger from baseline to after the real meal (mean difference=61.8, P<.001) but no significant change in hunger from before to after the virtual meal (mean difference=6.9, P=.10). There was no significant difference in food intake between the virtual and real meals (mean difference=36.8, P=.07). Meal duration was significantly shorter in the virtual meal (mean difference=?5.4, P<.001), which led to a higher eating rate (mean difference=82.9, P<.001). Some participants took bites and chewed during the virtual meal, but the number of bites and chews was lower than in the real meal. The meal duration was reduced from the first virtual meal to the second virtual meal, but no significant difference was observed between the 2 real meals. Conclusions: Eating a virtual meal does not appear to significantly reduce hunger in healthy individuals. Also, this methodology does not significantly result in eating behaviors identical to real-life conditions but does evoke chewing and bite behavior in certain individuals. Trial Registration: ClinicalTrials.gov NCT05734209, https://clinicaltrials.gov/ct2/show/NCT05734209 UR - https://games.jmir.org/2023/1/e44348 UR - http://dx.doi.org/10.2196/44348 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561558 ID - info:doi/10.2196/44348 ER - TY - JOUR AU - Guan, Vivienne AU - Zhou, Chenghuai AU - Wan, Hengyi AU - Zhou, Rengui AU - Zhang, Dongfa AU - Zhang, Sihan AU - Yang, Wangli AU - Voutharoja, Prakash Bhanu AU - Wang, Lei AU - Win, Than Khin AU - Wang, Peng PY - 2023/8/7 TI - A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study JO - JMIR Form Res SP - e46839 VL - 7 KW - food KW - diet KW - mobile health KW - mHealth KW - persuasive technology KW - gamification KW - computer vision KW - cloud computing KW - design science research KW - mobile phone N2 - Background: The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. Objective: This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. Methods: The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). Results: The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was ?acceptable,? with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. Conclusions: A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development. UR - https://formative.jmir.org/2023/1/e46839 UR - http://dx.doi.org/10.2196/46839 UR - http://www.ncbi.nlm.nih.gov/pubmed/37549000 ID - info:doi/10.2196/46839 ER - TY - JOUR AU - Amiri, Maryam AU - Li, Juan AU - Hasan, Wordh PY - 2023/8/3 TI - Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study JO - JMIR Form Res SP - e46434 VL - 7 KW - diabetes KW - fuzzy logic KW - meal planning KW - multicriteria decision-making KW - optimization N2 - Background: Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences. Objective: This study aimed to design an artificial intelligence (AI)?powered meal planner that can generate personalized healthy meal plans based on the user?s specific health conditions, personal preferences, and status. Methods: We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user?s health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user?s other preferences, we proposed a multicriteria decision-making approach. Results: We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user?s health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user?s preferences. The users were generally satisfied with the system and its features. Conclusions: We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people?s health and nutrition goals. UR - https://formative.jmir.org/2023/1/e46434 UR - http://dx.doi.org/10.2196/46434 UR - http://www.ncbi.nlm.nih.gov/pubmed/37535413 ID - info:doi/10.2196/46434 ER - TY - JOUR AU - Soltero, Erica AU - Lopez, Callie AU - Mihail, Sandra AU - Hernandez, Ayleen AU - Musaad, M. Salma AU - O'Connor, M. Teresia AU - Thompson, Debbe PY - 2023/8/2 TI - An SMS Text Message?Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process JO - JMIR Form Res SP - e46606 VL - 7 KW - Hispanic health KW - adolescents KW - digital health KW - physical activity KW - sleep KW - type 2 diabetes KW - mobile phone KW - smartphone N2 - Background: SMS text message?based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. Objective: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. Methods: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message?based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. Results: The background phase revealed that few SMS text message?based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Conclusions: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message?based strategies among high-risk adolescents. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2023.107117 UR - https://formative.jmir.org/2023/1/e46606 UR - http://dx.doi.org/10.2196/46606 UR - http://www.ncbi.nlm.nih.gov/pubmed/37531191 ID - info:doi/10.2196/46606 ER - TY - JOUR AU - Crane, Nicole AU - Hagerman, Charlotte AU - Horgan, Olivia AU - Butryn, Meghan PY - 2023/7/18 TI - Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study JO - JMIR Mhealth Uhealth SP - e45057 VL - 11 KW - weight loss KW - digital technology KW - diet KW - exercise KW - behavior change KW - mobile phone N2 - Background: Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence. Objective: This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3). Methods: Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling. Results: During WLM, consistently high rates of SM (?50% of the days in each month) were observed for 61% (44/72) of the participants for exercise, 40% (29/72) of the participants for weight, and 21% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50% of the days in a month), only 33% (17/51 for weight, 19/57 for diet) to 46% (13/28 for exercise) subsequently had ?1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03). Conclusions: Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement. UR - https://mhealth.jmir.org/2023/1/e45057 UR - http://dx.doi.org/10.2196/45057 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463017 ID - info:doi/10.2196/45057 ER - TY - JOUR AU - Li, Qifu AU - Huang, Gaoyangzi AU - Pei, Xianmei AU - Tang, Xin AU - Zhang, Renrui AU - Huang, Ya AU - Liu, Zili AU - Yi, Rong AU - Xing, Chonghui AU - Zhang, Xinghe AU - Guo, Taipin PY - 2023/7/10 TI - The Effect of Catgut Embedding at Acupoints Versus Nonacupoints in Abdominal Obesity: Protocol for a Multicenter, Double-Blind, 16-Week Randomized Controlled Trial JO - JMIR Res Protoc SP - e46863 VL - 12 KW - acupoint catgut embedding KW - nonacupoints KW - abdominal obesity KW - randomized controlled trial KW - protocol KW - waist circumference N2 - Background: Obesity is an increasing problem worldwide. The effective treatments for obesity mainly include diet, physical activity, behavioral intervention, pharmacotherapy, and bariatric surgery, which all have certain limitations. As a specific type of acupuncture therapy, acupoint catgut embedding (ACE) has gained substantial attention in the management of obesity in recent years. Previous studies suggested that ACE may be an effective obesity treatment. However, the evidence for the efficacy of ACE in abdominal obesity (AO) remains inadequate due to the paucity of high-quality studies. Objective: This study aims to investigate the difference in the effectiveness of catgut embedding at acupoints and catgut embedding at nonacupoints in patients with AO and to further validate the efficacy and safety of ACE for AO. Methods: This is a multicenter, double-blind, 16-week randomized controlled trial. A total of 92 eligible participants with AO will be randomly divided into 2 groups (1:1 allocation ratio). The ACE group will receive catgut embedding at acupoints and the control group will receive catgut embedding at nonacupoints. The intervention will be performed every 2 weeks for a total of 6 sessions. Follow-up will be performed every 2 weeks for a total of 2 visits. The primary outcome is waist circumference. Secondary outcomes include body weight, BMI, hip circumference, and the visual analog scale of appetite. Upon the completion of the trial, we will evaluate the effect of catgut embedding at acupoints or nonacupoints on obesity indicators in patients with AO. For treatment outcomes, an intention-to-treat analysis will be performed. Results: The start of recruitment began in August 2019 and is expected to end in September 2023. Conclusions: Although studies have been conducted to demonstrate the effectiveness of ACE in the treatment of obesity, the evidence for the efficacy of ACE in AO remains insufficient due to the quality of the studies. This rigorous normative randomized controlled trial will verify the effect of catgut embedding at acupoints or nonacupoints in patients with AO. The findings will provide credible evidence as to whether ACE is an effective and safe treatment for AO. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016947; https://tinyurl.com/2p82257p International Registered Report Identifier (IRRID): DERR1-10.2196/46863 UR - https://www.researchprotocols.org/2023/1/e46863 UR - http://dx.doi.org/10.2196/46863 UR - http://www.ncbi.nlm.nih.gov/pubmed/37428535 ID - info:doi/10.2196/46863 ER - TY - JOUR AU - Wren, M. Gina AU - Koutoukidis, A. Dimitrios AU - Scragg, Jadine AU - Whitman, Michael AU - Jebb, Susan PY - 2023/7/5 TI - The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program JO - J Med Internet Res SP - e43869 VL - 25 KW - obesity KW - overweight KW - weight loss KW - goals KW - motivation KW - mobile app KW - mobile health KW - mHealth KW - behavior change KW - mobile phone N2 - Background: Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. Objective: We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. Methods: This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ?25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. Results: Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). Conclusions: Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality. UR - https://www.jmir.org/2023/1/e43869 UR - http://dx.doi.org/10.2196/43869 UR - http://www.ncbi.nlm.nih.gov/pubmed/37405833 ID - info:doi/10.2196/43869 ER - TY - JOUR AU - Sae-lee, Kittiya AU - Surangsrirat, Decho AU - Parlawong, Chanatip AU - Anawilkul, T-touch AU - Assawachamrun, Narinuch AU - Boonbandan, Pawanya AU - Ladapongpuwat, Paweerata AU - Chupetch, Bhawat AU - Thongchai, Supatcha AU - Pruphetkaew, Nannapat AU - Thongseiratch, Therdpong AU - Vichitkunakorn, Polathep AU - Ngamchaliew, Pitchayanont PY - 2023/6/30 TI - Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge JO - JMIR Form Res SP - e45298 VL - 7 KW - generations KW - logging frequency KW - mobile health app KW - weight status KW - weight reduction N2 - Background: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. Objective: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. Methods: A secondary data analysis was performed using data collected from the ?MED PSU×ThaiSook Healthier Challenge,? a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ?30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (?80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). Results: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was ?3.85% (IQR ?3.40% to ?4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of ?1.08% (IQR ?2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). Conclusions: More than half of the ?MED PSU×ThaiSook Healthier Challenge? participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction. UR - https://formative.jmir.org/2023/1/e45298 UR - http://dx.doi.org/10.2196/45298 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389918 ID - info:doi/10.2196/45298 ER - TY - JOUR AU - Kohl, Jan AU - Brame, Judith AU - Centner, Christoph AU - Wurst, Ramona AU - Fuchs, Reinhard AU - Sehlbrede, Matthias AU - Tinsel, Iris AU - Maiwald, Phillip AU - Fichtner, Alexander Urs AU - Armbruster, Christoph AU - Farin-Glattacker, Erik AU - Gollhofer, Albert AU - König, Daniel PY - 2023/6/27 TI - Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial JO - J Med Internet Res SP - e43426 VL - 25 KW - web-based intervention KW - randomized controlled trial KW - dietary energy density KW - weight loss, obesity KW - overweight KW - cardiometabolic risk factors N2 - Background: The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. Objective: The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. Methods: The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. Results: The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. Conclusions: The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. Trial Registration: German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249 International Registered Report Identifier (IRRID): RR2-10.3390/ijerph19031393 UR - https://www.jmir.org/2023/1/e43426 UR - http://dx.doi.org/10.2196/43426 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368484 ID - info:doi/10.2196/43426 ER - TY - JOUR AU - van der Haar, Sandra AU - Raaijmakers, Ireen AU - Verain, D. Muriel C. AU - Meijboom, Saskia PY - 2023/6/20 TI - Incorporating Consumers? Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e39515 VL - 11 KW - mobile health KW - mHealth KW - mHealth apps KW - nutrition apps KW - diet apps KW - consumer needs KW - app KW - use KW - nutrition KW - tool KW - consumer KW - eating KW - habit KW - users KW - dietary behavior KW - reliable KW - food KW - database KW - time KW - developers KW - mobile phone N2 - Background: Nutrition apps seem to be promising tools for supporting consumers toward healthier eating habits. There is a wide variety of nutrition apps available; however, users often discontinue app use at an early stage before a permanent change in dietary behavior can be achieved. Objective: The main objective of this study was to identify, from both a user and nonuser perspective, which functionalities should be included in nutrition apps to increase intentions to start and maintain use of these apps. A secondary objective was to gain insight into reasons to quit using nutrition apps at an early stage. Methods: This study used a mixed methods approach and included a qualitative and a quantitative study. The qualitative study (n=40) consisted of a home-use test with 6 commercially available nutrition apps, followed by 6 focus group discussions (FGDs) to investigate user experiences. The quantitative study was a large-scale survey (n=1420), which was performed in a representative sample of the Dutch population to quantify the FGDs? results. In the survey, several app functionalities were rated on 7-point Likert scales ranging from 1 (very unimportant) to 7 (very important). Results: A total of 3 different phases of app use, subdivided into 10 user-centric app aspects and 46 associated app functionalities, were identified as relevant nutrition app elements in the FGDs. Relevance was confirmed in the survey, as all user-centric aspects and almost all app functionalities were rated as important to include in a nutrition app. In the starting phase, a clear introduction (mean 5.45, SD 1.32), purpose (mean 5.40, SD 1.40), and flexible food tracking options (mean 5.33, SD 1.45) were the most important functionalities. In the use phase, a complete and reliable food product database (mean 5.58, SD 1.41), easy navigation (mean 5.56, SD 1.36), and limited advertisements (mean 5.53, SD 1.51) were the most important functionalities. In the end phase, the possibility of setting realistic goals (mean 5.23, SD 1.44), new personal goals (mean 5.13, SD 1.45), and continuously offering new information (mean 4.88, SD 1.44) were the most important functionalities. No large differences between users, former users, and nonusers were found. The main reason for quitting a nutrition app in the survey was the high time investment (14/38, 37%). This was also identified as a barrier in the FGDs. Conclusions: Nutrition apps should be supportive in all 3 phases of use (start, use, and end) to increase consumers? intentions to start and maintain the use of these apps and achieve a change in dietary behavior. Each phase includes several key app functionalities that require specific attention from app developers. High time investment is an important reason to quit nutrition app use at an early stage. UR - https://mhealth.jmir.org/2023/1/e39515 UR - http://dx.doi.org/10.2196/39515 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338978 ID - info:doi/10.2196/39515 ER - TY - JOUR AU - Savila, Faasisila AU - Harding, Truely AU - Swinburn, Boyd AU - Bagg, Warwick AU - Letele, Dave AU - Laban, Fuatino AU - Goodyear-Smith, Felicity PY - 2023/6/16 TI - Building Culturally Centered System Dynamics Logic Models for the Brown Buttabean Motivation Organization: Protocol for a Systems Science Approach JO - JMIR Res Protoc SP - e44229 VL - 12 KW - systems logic model KW - cognitive mapping interview KW - group model building KW - community network KW - healthy lifestyle KW - weight reduction programs N2 - Background: Brown Buttabean Motivation (BBM) is an organization providing support for Pacific people and Indigenous M?ori to manage their weight, mainly through community-based exercise sessions and social support. It was started by DL, a man of Samoan and M?ori descent, following his personal weight loss journey from a peak weight of 210 kg to less than half that amount. DL is a charismatic leader with a high media profile who is successful in soliciting donations from corporations in money and kindness. Over time, BBM?s activities have evolved to include healthy eating, food parcel provision, and other components of healthy living. A co-design team of university researchers and BBM staff are evaluating various components of the program and organization. Objective: The purpose of this study is to build culturally centered system dynamics logic models to serve as the agreed theories of change for BBM and provide a basis for its ongoing effectiveness, sustainability, and continuous quality improvements. Methods: A systems science approach will clarify the purpose of BBM and identify the systemic processes needed to effectively and sustainably achieve the study?s purpose. Cognitive mapping interviews with key stakeholders will produce maps of their conceptions of BBM?s goals and related cause-and-effect processes. The themes arising from the analysis of these maps will provide the initial indicators of change to inform the questions for 2 series of group model building workshops. In these workshops, 2 groups (BBM staff and BBM members) will build qualitative systems models (casual loop diagrams), identifying feedback loops in the structures and processes of the BBM system that will enhance the program?s effectiveness, sustainability, and quality improvement. The Pacific and M?ori team members will ensure that workshop content, processes, and outputs are grounded in cultural approaches appropriate for the BBM community, with several Pacific and M?ori frameworks informing the methods. These include the Samoan fa?afaletui research framework, which requires different perspectives to be woven together to create new knowledge, and kaupapa M?ori?aligned research approaches, which create a culturally safe space to conduct research by, with, and for M?ori. The Pacific fonofale and M?ori te whare tapa wh? holistic frameworks for interpreting people?s dimensions of health and well-being will also inform this study. Results: Systems logic models will inform BBM?s future developments as a sustainable organization and support its growth and development beyond its high dependence on DL?s charismatic leadership. Conclusions: This study will adopt a novel and innovative approach to co-designing culturally centered system dynamics logic models for BBM by using systems science methods embedded within Pacific and M?ori worldviews and weaving together a number of frameworks and methodologies. These will form the theories of change to enhance BBM?s effectiveness, sustainability, and continuous improvement. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN 12621-00093-1875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382320 International Registered Report Identifier (IRRID): PRR1-10.2196/44229 UR - https://www.researchprotocols.org/2023/1/e44229 UR - http://dx.doi.org/10.2196/44229 UR - http://www.ncbi.nlm.nih.gov/pubmed/37327034 ID - info:doi/10.2196/44229 ER - TY - JOUR AU - Champion, E. Katrina AU - Chapman, Cath AU - Sunderland, Matthew AU - Slade, Tim AU - Barrett, Emma AU - Kelly, Erin AU - Stapinski, Lexine AU - Gardner, A. Lauren AU - Teesson, Maree AU - Newton, C. Nicola PY - 2023/6/15 TI - Associations Between Personality Traits and Energy Balance Behaviors in Emerging Adulthood: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e42244 VL - 9 KW - personality KW - emerging adulthood KW - screen time KW - sedentary KW - sleep KW - diet KW - physical activity KW - prevention KW - mental health KW - risk factor KW - sedentary behavior KW - chronic disease N2 - Background: Internalizing and externalizing personality traits are robust risk factors for substance use and mental health, and personality-targeted interventions are effective in preventing substance use and mental health problems in youth. However, there is limited evidence for how personality relates to other lifestyle risk factors, such as energy balance?related behaviors, and how this might inform prevention efforts. Objective: This study aimed to examine concurrent cross-sectional associations between personality traits (ie, hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) and sleep, diet, physical activity (PA), and sedentary behaviors (SB), 4 of the leading risk factors for chronic disease, among emerging adults. Methods: Data were drawn from a cohort of young Australians who completed a web-based, self-report survey in 2019 during early adulthood. A series of Poisson and logistic regressions were conducted to examine the concurrent associations between the risk behaviors (sleep, diet, PA, and sitting and screen time) and personality traits (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) among emerging adults in Australia. Results: A total of 978 participants (mean age 20.4, SD 0.5 years) completed the web-based survey. The results indicated that higher scores on hopelessness were associated with a greater daily screen (risk ratio [RR] 1.12, 95% CI 1.10-1.15) and sitting time (RR 1.05, 95% CI 1.0-1.08). Similarly, higher scores on anxiety sensitivity were associated with a greater screen (RR 1.04, 95% CI 1.02-1.07) and sitting time (RR 1.04, 95% CI 1.02-1.07). Higher impulsivity was associated with greater PA (RR 1.14, 95% CI 1.08-1.21) and screen time (RR 1.06, 95% CI 1.03-1.08). Finally, higher scores on sensation seeking were associated with greater PA (RR 1.08, 95% CI 1.02-1.14) and lower screen time (RR 0.96, 95% CI 0.94-0.99). Conclusions: The results suggest that personality should be considered when designing preventive interventions for lifestyle risk behaviors, particularly in relation to SB, such as sitting and screen time. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000026820; https://tinyurl.com/ykwcxspr UR - https://publichealth.jmir.org/2023/1/e42244 UR - http://dx.doi.org/10.2196/42244 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318870 ID - info:doi/10.2196/42244 ER - TY - JOUR AU - Nicol, E. Ginger AU - Jansen, O. Madeline AU - Ricchio, R. Amanda AU - Schweiger, A. Julia AU - Keenoy, E. Katie AU - Miller, Philip J. AU - Morrato, H. Elaine AU - Guo, Zhaohua AU - Evanoff, A. Bradley AU - Parks, J. Joseph AU - Newcomer, W. John PY - 2023/6/9 TI - Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial JO - JMIR Res Protoc SP - e42114 VL - 12 KW - community mental health services KW - implementation science KW - mental disorders KW - obesity KW - primary prevention N2 - Background: Obesity is common in individuals with severe mental illness (SMI), contributing to a significantly shortened lifespan when compared to the general population. Available weight loss treatments have attenuated efficacy in this population, underscoring the importance of prevention and early intervention. Objective: Here, we describe a type 1 hybrid study design for adapting and pilot-testing an existing mobile health intervention for obesity prevention in individuals with early SMI and Class I or early-stage obesity, defined as a BMI of 30-35. Methods: An existing, evidence-based interactive obesity treatment approach using low-cost, semiautomated SMS text messaging was selected for adaptation. Community mental health clinics and Clubhouse settings in Eastern Missouri and South Florida were identified to participate. This study has the following 3 aims. First, using the Enhanced Framework for Reporting Adaptations and Modifications to Evidence-based interventions, contextual aspects of the clinical and digital treatment environments are identified for adaptation, considering 5 main stakeholder groups (clinical administrators, prescribing clinicians, case managers, nurses, and patients). Following a 2-week trial of unadapted SMS text messaging, Innovation Corps methods are used to discover needed intervention adaptations by stakeholder group and clinical setting. Second, adaptations to digital functionality and intervention content will be made based on themes identified in aim 1, followed by rapid usability testing with key stakeholders. A process for iterative treatment adaptation will be developed for making unplanned modifications during the aim 3 implementation pilot study. Individuals working in partner community mental health clinics and Clubhouse settings will be trained in intervention delivery. Third, in a randomized pilot and feasibility trial, adults with 5 years or less of treatment for an SMI diagnosis will be randomized 2:1 to 6 months of an adapted interactive obesity treatment approach or to an attentional control condition, followed by a 3-month extension phase of SMS text messages only. Changes in weight, BMI, and behavioral outcomes, as well as implementation challenges, will be evaluated at 6 and 9 months. Results: Institutional review board approval for aims 1 and 2 was granted on August 12, 2018, with 72 focus group participants enrolled; institutional review board approval for aim 3 was granted on May 6, 2020. To date, 52 participants have been enrolled in the study protocol. Conclusions: In this type 1 hybrid study design, we apply an evidence-based treatment adaptation framework to plan, adapt, and feasibility test a mobile health intervention in real-world treatment settings. Resting at the intersection of community mental health treatment and physical health promotion, this study aims to advance the use of simple technology for obesity prevention in individuals with early-stage mental illness. Trial Registration: ClinicalTrials.gov NCT03980743; https://clinicaltrials.gov/ct2/show/NCT03980743 International Registered Report Identifier (IRRID): DERR1-10.2196/42114 UR - https://www.researchprotocols.org/2023/1/e42114 UR - http://dx.doi.org/10.2196/42114 UR - http://www.ncbi.nlm.nih.gov/pubmed/37294604 ID - info:doi/10.2196/42114 ER - TY - JOUR AU - Hanson, Petra AU - Summers, Charlotte AU - Panesar, Arjun AU - Liarakos, Leonidas Alexandros AU - Oduro-Donkor, Dominic AU - Whyte Oshodi, Danniella AU - Hailston, Luke AU - Randeva, Harpal AU - Menon, Vinod AU - de la Fosse, Michaela AU - Kaura, Amit AU - Shuttlewood, Emma AU - Loveder, Mark AU - Poole, Donna AU - Barber, M. Thomas PY - 2023/5/31 TI - Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study JO - JMIR Hum Factors SP - e41256 VL - 10 KW - weight management KW - precision health KW - digital health, hospital KW - secondary care KW - tier 3 weight management KW - National Health Service KW - weight KW - obese KW - obesity KW - focus group KW - perspective KW - opinion KW - attitude KW - behavior change KW - mHealth KW - mobile health KW - health app N2 - Background: Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. Objective: The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. Methods: This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients? views on the use of digital tools as part of a specialist weight management service. Results: A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. Conclusions: It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services. UR - https://humanfactors.jmir.org/2023/1/e41256 UR - http://dx.doi.org/10.2196/41256 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256653 ID - info:doi/10.2196/41256 ER - TY - JOUR AU - Teshome, Berhanu Getenesh AU - Haileslassie, Abebe Hiwot AU - Shand, Phyllis AU - Lin, Yun AU - Lieffers, L. Jessica R. AU - Henry, Carol PY - 2023/5/31 TI - Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study JO - JMIR Form Res SP - e45908 VL - 7 KW - adolescents KW - food literacy KW - high school KW - macronutrients KW - micronutrients KW - pulses KW - dietary pattern KW - diet KW - eating habits KW - nutrition KW - students KW - school-based interventions N2 - Background: Promoting pulse consumption in schools could improve students? healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students. UR - https://formative.jmir.org/2023/1/e45908 UR - http://dx.doi.org/10.2196/45908 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256666 ID - info:doi/10.2196/45908 ER - TY - JOUR AU - Noh, Eunyoung AU - Won, Jiyoon AU - Jo, Sua AU - Hahm, Dae-Hyun AU - Lee, Hyangsook PY - 2023/5/26 TI - Conversational Agents for Body Weight Management: Systematic Review JO - J Med Internet Res SP - e42238 VL - 25 KW - conversational agent KW - chatbot KW - obesity KW - weight management KW - artificial intelligence KW - behavioral therapy N2 - Background: Obesity is a public health issue worldwide. Conversational agents (CAs), also frequently called chatbots, are computer programs that simulate dialogue between people. Owing to better accessibility, cost-effectiveness, personalization, and compassionate patient-centered treatments, CAs are expected to have the potential to provide sustainable lifestyle counseling for weight management. Objective: This systematic review aimed to critically summarize and evaluate clinical studies on the effectiveness and feasibility of CAs with unconstrained natural language input for weight management. Methods: PubMed, Embase, the Cochrane Library (CENTRAL), PsycINFO, and ACM Digital Library were searched up to December 2022. Studies were included if CAs were used for weight management and had a capability for unconstrained natural language input. No restrictions were imposed on study design, language, or publication type. The quality of the included studies was assessed using the Cochrane risk-of-bias assessment tool or the Critical Appraisal Skills Programme checklist. The extracted data from the included studies were tabulated and narratively summarized as substantial heterogeneity was expected. Results: In total, 8 studies met the eligibility criteria: 3 (38%) randomized controlled trials and 5 (62%) uncontrolled before-and-after studies. The CAs in the included studies were aimed at behavior changes through education, advice on food choices, or counseling via psychological approaches. Of the included studies, only 38% (3/8) reported a substantial weight loss outcome (1.3-2.4 kg decrease at 12-15 weeks of CA use). The overall quality of the included studies was judged as low. Conclusions: The findings of this systematic review suggest that CAs with unconstrained natural language input can be used as a feasible interpersonal weight management intervention by promoting engagement in psychiatric intervention-based conversations simulating treatments by health care professionals, but currently there is a paucity of evidence. Well-designed rigorous randomized controlled trials with larger sample sizes, longer treatment duration, and follow-up focusing on CAs? acceptability, efficacy, and safety are warranted. UR - https://www.jmir.org/2023/1/e42238 UR - http://dx.doi.org/10.2196/42238 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234029 ID - info:doi/10.2196/42238 ER - TY - JOUR AU - Lord, Z. Asta Y. AU - Pan, Wen-Harn PY - 2023/5/25 TI - Effects of WAKE.TAIWAN Healthy Lifestyle Web-Based Promotion Programs on Adults? Awareness of Self-perceived Weight Status and Their Healthy Lifestyle Stages: Retrospective Analysis JO - JMIR Form Res SP - e41944 VL - 7 KW - healthy eating KW - active living KW - obese KW - weight KW - social media KW - website KW - web based KW - health behavior KW - online health promotion KW - obesity KW - chronic disease KW - healthy lifestyle KW - lifestyle KW - health promotion KW - health education KW - online health information KW - quasi-experimental KW - questionnaire KW - survey research KW - applied method KW - nutrition KW - food KW - eat KW - confidence interval KW - generalized linear model N2 - Background: Obesity is a major risk factor of many chronic diseases. However, current obesity control policies and actions are not sufficient to halt the pandemic. It has been documented that more than half of all adults are not able to interpret their own weight status, not to mention to practice healthy lifestyles. Social media and interactive websites can reach people on a long-term basis, which may be used as intervention vehicles to build up cognition for weight control and to promote healthy behavior practices. Objective: WAKE.TAIWAN is an ongoing web-based multifaceted healthy lifestyle promotion program with social media and interactive websites as the intervention vehicle. This study aimed to examine whether adults reached by our program would have increased awareness to their own anthropometric measures, correctly judge their body weight status, and practice healthy behaviors over time. Methods: This study adopted a quasi-experimental design with web-based questionnaire surveys. The experimental group consisted of WAKE.TAIWAN Facebook group members aged 20-65 years who have used the interactive website health education resources (n=177). The group was further stratified into 2 subgroups based on their duration of participation (E1 group: duration <1 year; E2 group: duration ?1 year). The control group consisted of other Facebook users (n=545) in the same age range who had not been exposed to the health education materials of this project. A total of 722 people (male: n=267, 37%; and female: n=455, 63%) participated in our survey in 2019. Data were analyzed to evaluate program effectiveness using a generalized linear model. Results: The proportion of people correctly interpreting their own weight status in the experimental group was greater than that of the control group (control group: 320/545, 58.7%; group E1: 53/88, 60%; and group E2: 64/89, 72%). The E2 experimental group was significantly better than the control group in paying attention to weight-related measures and in correctly interpreting their own weight status (odds ratio 1.73, 95% CI 1.04-2.89; P=.04). With respect to the behavioral stages of practicing healthy eating and active living, both experimental groups, E1 and E2, performed significantly better than the control group (group E1: P=.003 and P=.02; and group E2: P=.004 and P<.001, respectively). Conclusions: This study demonstrates that the longer the participants were exposed to our social media?based programs, the higher the proportion of them that would have the correct judgement on their weight status and fall in the higher stages of healthy lifestyle behaviors. A longitudinal follow-up survey is in place to verify these findings. UR - https://formative.jmir.org/2023/1/e41944 UR - http://dx.doi.org/10.2196/41944 UR - http://www.ncbi.nlm.nih.gov/pubmed/37227770 ID - info:doi/10.2196/41944 ER - TY - JOUR AU - Yau, W. Kiana AU - Tang, S. Tricia AU - Görges, Matthias AU - Pinkney, Susan AU - Amed, Shazhan PY - 2023/5/17 TI - Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development JO - JMIR Pediatr Parent SP - e44792 VL - 6 KW - childhood obesity KW - mobile health KW - health behaviors KW - prevention KW - mobile health app KW - mHealth app KW - human-centered design KW - cocreation KW - participatory approach KW - mobile phone N2 - Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ?5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ?1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children?s Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ?2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users? behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users? interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. UR - https://pediatrics.jmir.org/2023/1/e44792 UR - http://dx.doi.org/10.2196/44792 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195754 ID - info:doi/10.2196/44792 ER - TY - JOUR AU - Arguello, Diego AU - Cloutier, Gregory AU - Thorndike, N. Anne AU - Castaneda Sceppa, Carmen AU - Griffith, John AU - John, Dinesh PY - 2023/5/16 TI - Impact of Sit-to-Stand and Treadmill Desks on Patterns of Daily Waking Physical Behaviors Among Overweight and Obese Seated Office Workers: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e43018 VL - 25 KW - prolonged sedentary behavior KW - sedentary behavior KW - sit-to-stand desks KW - treadmill desks KW - physical activity promotion KW - workplace wellness KW - seated office workers KW - move more and sit less N2 - Background: Sit-to-stand and treadmill desks may help sedentary office workers meet the physical activity guideline to ?move more and sit less,? but little is known about their long-term impact on altering the accumulation patterns of physical behaviors. Objective: This study explores the impact of sit-to-stand and treadmill desks on physical behavior accumulation patterns during a 12-month multicomponent intervention with an intent-to-treat design in overweight and obese seated office workers. Methods: In total, 66 office workers were cluster randomized into a seated desk control (n=21, 32%; 8 clusters), sit-to-stand desk (n=23, 35%; 9 clusters), or treadmill desk (n=22, 33%; 7 clusters) group. Participants wore an activPAL (PAL Technologies Ltd) accelerometer for 7 days at baseline, 3-month follow-up (M3), 6-month follow-up (M6), and 12-month follow-up (M12) and received periodic feedback on their physical behaviors. Analyses of physical behavior patterns included total day and workday number of sedentary, standing, and stepping bouts categorized into durations ranging from 1 to 60 and >60 minutes and usual sedentary, standing, and stepping bout durations. Intervention trends were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. Results: The treadmill desk group favored prolonged sedentary bouts (>60 min), whereas the sit-to-stand desk group accrued more short-duration sedentary bouts (<20 min). Therefore, compared with controls, sit-to-stand desk users had shorter usual sedentary bout durations short-term (total day ?M3: ?10.1 min/bout, 95% CI ?17.9 to ?2.2; P=.01; workday ?M3: ?20.3 min/bout, 95% CI ?37.7 to ?2.9; P=.02), whereas treadmill desk users had longer usual sedentary bout durations long-term (total day ?M12: 9.0 min/bout, 95% CI 1.6-16.4; P=.02). The treadmill desk group favored prolonged standing bouts (30-60 min and >60 min), whereas the sit-to-stand desk group accrued more short-duration standing bouts (<20 min). As such, relative to controls, treadmill desk users had longer usual standing bout durations short-term (total day ?M3: 6.9 min/bout, 95% CI 2.5-11.4; P=.002; workday ?M3: 8.9 min/bout, 95% CI 2.1-15.7; P=.01) and sustained this long-term (total day ?M12: 4.5 min/bout, 95% CI 0.7-8.4; P=.02; workday ?M12: 5.8 min/bout, 95% CI 0.9-10.6; P=.02), whereas sit-to-stand desk users showed this trend only in the long-term (total day ?M12: 4.2 min/bout, 95% CI 0.1-8.3; P=.046). The treadmill desk group accumulated more stepping bouts across various bins of duration (5-50 min), primarily at M3. Thus, treadmill desk users had longer usual stepping bout durations in the short-term compared with controls (workday ?M3: 4.8 min/bout, 95% CI 1.3-8.3; P=.007) and in the short- and long-term compared with sit-to-stand desk users (workday ?M3: 4.7 min/bout, 95% CI 1.6-7.8; P=.003; workday ?M12: 3.0 min/bout, 95% CI 0.1-5.9; P=.04). Conclusions: Sit-to-stand desks exerted potentially more favorable physical behavior accumulation patterns than treadmill desks. Future active workstation trials should consider strategies to promote more frequent long-term movement bouts and dissuade prolonged static postural fixity. Trial Registration: ClinicalTrials.gov NCT02376504; https://clinicaltrials.gov/ct2/show/NCT02376504 UR - https://www.jmir.org/2023/1/e43018 UR - http://dx.doi.org/10.2196/43018 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191995 ID - info:doi/10.2196/43018 ER - TY - JOUR AU - Pollack, Catherine AU - Gilbert-Diamond, Diane AU - Onega, Tracy AU - Vosoughi, Soroush AU - O'Malley, James A. AU - Emond, A. Jennifer PY - 2023/5/16 TI - Obesity-Related Discourse on Facebook and Instagram Throughout the COVID-19 Pandemic: Comparative Longitudinal Evaluation JO - JMIR Infodemiology SP - e40005 VL - 3 KW - obesity KW - Facebook KW - Instagram KW - COVID-19 KW - social media KW - news KW - infodemiology KW - public health KW - online health information N2 - Background: COVID-19 severity is amplified among individuals with obesity, which may have influenced mainstream media coverage of the disease by both improving understanding of the condition and increasing weight-related stigma. Objective: We aimed to measure obesity-related conversations on Facebook and Instagram around key dates during the first year of the COVID-19 pandemic. Methods: Public Facebook and Instagram posts were extracted for 29-day windows in 2020 around January 28 (the first US COVID-19 case), March 11 (when COVID-19 was declared a global pandemic), May 19 (when obesity and COVID-19 were linked in mainstream media), and October 2 (when former US president Trump contracted COVID-19 and obesity was mentioned most frequently in the mainstream media). Trends in daily posts and corresponding interactions were evaluated using interrupted time series. The 10 most frequent obesity-related topics on each platform were also examined. Results: On Facebook, there was a temporary increase in 2020 in obesity-related posts and interactions on May 19 (posts +405, 95% CI 166 to 645; interactions +294,930, 95% CI 125,986 to 463,874) and October 2 (posts +639, 95% CI 359 to 883; interactions +182,814, 95% CI 160,524 to 205,105). On Instagram, there were temporary increases in 2020 only in interactions on May 19 (+226,017, 95% CI 107,323 to 344,708) and October 2 (+156,974, 95% CI 89,757 to 224,192). Similar trends were not observed in controls. Five of the most frequent topics overlapped (COVID-19, bariatric surgery, weight loss stories, pediatric obesity, and sleep); additional topics specific to each platform included diet fads, food groups, and clickbait. Conclusions: Social media conversations surged in response to obesity-related public health news. Conversations contained both clinical and commercial content of possibly dubious accuracy. Our findings support the idea that major public health announcements may coincide with the spread of health-related content (truthful or otherwise) on social media. UR - https://infodemiology.jmir.org/2023/1/e40005 UR - http://dx.doi.org/10.2196/40005 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191990 ID - info:doi/10.2196/40005 ER - TY - JOUR AU - Liang, Jinghong AU - Huang, Shan AU - Jiang, Nan AU - Kakaer, Aerziguli AU - Chen, Yican AU - Liu, Meiling AU - Pu, Yingqi AU - Huang, Shaoyi AU - Pu, Xueya AU - Zhao, Yu AU - Chen, Yajun PY - 2023/5/10 TI - Association Between Joint Physical Activity and Dietary Quality and Lower Risk of Depression Symptoms in US Adults: Cross-sectional NHANES Study JO - JMIR Public Health Surveill SP - e45776 VL - 9 KW - physical activity KW - dietary quality KW - depression symptom KW - adults KW - NHANES N2 - Background: Depression escalating public health concern and the modest efficacy of currently available treatments have prompted efforts to identify modifiable risk factors associated with depression symptoms. Physical inactivity, poor nutrition, or other lifestyle behaviors are among the potentially modifiable risk factors most consistently linked with depression. Past evidence regarding the single effect of physical activity (PA) or dietary quality (DQ) on reducing the risk of depression symptoms has been well-documented. However, the association of the joint effect of PA and DQ on depression symptoms has never been investigated in a representative sample of adults. Objective: This study investigates the association between PA and depression symptoms and between DQ and depression symptoms, and their combined effects on US adults. Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018 cycles. The primary exposures were DQ and PA, measured using the Healthy Eating Index (HEI)-2015 and the metabolic equivalent (MET) minutes per week reported in questionnaires, respectively. Depression symptoms were defined as a 9-item Patient Health Questionnaire (PHQ-9) score of ?10. We created 4 lifestyle categories: healthy diet and active individuals, unhealthy diet but active individuals, healthy diet but inactive individuals, and unhealthy diet and inactive individuals. Participants were considered to have a healthy diet if they fell within the 60th percentile of the HEI-2015 or to be active if they met the current guidelines for PA. A survey-multivariable logistic regression approach was used to model adjust the variables relevant to the associations, and an age-adjusted prevalence for depression symptoms was calculated following the NHANES guidelines. Results: In total, 19,295 participants represented a weighted number of 932.5 million adults aged 20 to 80 years in the noninstitutionalized US population. The total age-adjusted prevalence of depression symptoms among all respondents was 7.08% (1507/19,295). Of the respondents, 81.97% (15,816/19,295) met the PA recommendation and 26.79% (5170/19,295) scored at or above the 60th percentile on the HEI-2015. Depression symptoms were inversely associated with a higher level of PA (adjusted odds ratio [AOR] 0.819, 95% CI 0.716-0.938) and healthy DQ (AOR 0.809, 95% CI 0.701-0.931), respectively. A healthy diet combined with recommended PA was associated with a significantly lower risk of depression symptoms (AOR 0.658, 95% CI 0.538-0.803) than those who consumed an unhealthy diet but were physically active (AOR 0.890, 95% CI 0.765-1.038) or consumed a healthy diet but were physically inactive (AOR 1.077, 95% CI 0.817-1.406). Conclusions: Our findings indicate that people with a healthy diet and recommended PA have a lower risk of depression symptoms than those with an unhealthy diet and a low level of PA. A healthy dietary habit and regular PA are potential precautions against depression. UR - https://publichealth.jmir.org/2023/1/e45776 UR - http://dx.doi.org/10.2196/45776 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163324 ID - info:doi/10.2196/45776 ER - TY - JOUR AU - Tham, Cong Xiang AU - Whitton, Clare AU - Müller-Riemenschneider, Falk AU - Petrunoff, Alexander Nicholas PY - 2023/5/9 TI - Young Adults? Use of Mobile Food Delivery Apps and the Potential Impacts on Diet During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e38959 VL - 7 KW - young adults KW - food delivery KW - mobile app KW - COVID-19 KW - diet KW - sugar-sweetened beverages KW - mixed methods KW - fruits KW - vegetables KW - physical activity KW - mobile phone N2 - Background: A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective: We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods: A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results: The quantitative results revealed that 41.7% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions: This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post?COVID-19 new normal on dietary patterns and physical activity levels. UR - https://formative.jmir.org/2023/1/e38959 UR - http://dx.doi.org/10.2196/38959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018540 ID - info:doi/10.2196/38959 ER - TY - JOUR AU - Li, Cheng AU - Li, Yanzhi AU - Zhao, Min AU - Zhang, Cheng AU - Bovet, Pascal AU - Xi, Bo PY - 2023/5/8 TI - Using the New ?Life?s Essential 8? Metrics to Evaluate Trends in Cardiovascular Health Among US Adults From 2005 to 2018: Analysis of Serial Cross-sectional Studies JO - JMIR Public Health Surveill SP - e45521 VL - 9 KW - trends KW - cardiovascular health KW - primordial prevention KW - adult KW - nutrition examination KW - survey KW - diet KW - physical activity KW - data collection KW - cross-sectional N2 - Background: The recently published ?Life?s Essential 8? (LE8) by the American Heart Association has overcome some limitations in evaluating cardiovascular health (CVH) in the previous ?Life?s Simple 7.? Objective: We aimed to examine the secular trends in CVH, as assessed by the LE8, in US adults from 2005 to 2018. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey between 2005-2006 and 2017-2018, we calculated the age-standardized mean scores of overall CVH and each of the LE8 components, where a higher score (range 0-100 points) means a better health status. A total of 21,667 adults aged 20-79 years were included in this analysis. Results: The overall CVH did not significantly change between 2005-2006 and 2017-2018 (65.5, 95% CI 63.9-67.1 to 65.0, 95% CI 62.8-67.1; P=.82). The individual metrics did not significantly change for diet (41.0, 95% CI 38.0-43.9 to 41.5, 95% CI 36.5-46.6; P=.94), physical activity (57.5, 95% CI 53.0-61.9 to 53.0, 95% CI 48.7-57.3; P=.26), and blood pressure (68.4, 95% CI 65.2-71.5 to 68.6, 95% CI 65.3-71.9, P=.35), improved for nicotine exposure (64.7, 95% CI 61.1-68.4 to 71.9, 95% CI 67.7-76.2; P<.001), sleep health (83.7, 95% CI 81.6-85.7 to 84.1, 95% CI 81.2-87.1; P=.006), and blood lipids (61.6, 95% CI 59.1-64.0 to 67.0, 95% CI 63.5-70.4; P<.001), and worsened for BMI (63.4, 95% CI 59.7-67.1 to 56.2, 95% CI 52.5-59.9; P<.001) and blood glucose (83.9, 95% CI 82.4-85.4 to 77.4, 95% CI 74.5-80.3; P<.001). Conclusions: According to the LE8, the overall CVH did not change among US adults from 2005 to 2018, as well as 3 components (diet, physical activity, and blood pressure). Other metrics such as nicotine exposure, blood lipids, and sleep health improved, while BMI and blood glucose deteriorated over time. UR - https://publichealth.jmir.org/2023/1/e45521 UR - http://dx.doi.org/10.2196/45521 UR - http://www.ncbi.nlm.nih.gov/pubmed/37155232 ID - info:doi/10.2196/45521 ER - TY - JOUR AU - Zhang, Na AU - Zhou, Mingzhu AU - Li, Muxia AU - Ma, Guansheng PY - 2023/4/28 TI - Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial JO - J Med Internet Res SP - e41926 VL - 25 KW - overweight and obesity KW - remote interventions KW - older population KW - dietary intake KW - physical activity KW - weight management KW - health KW - mobile phone N2 - Background: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. Objective: The objective of this study was to assess the effects of remote interventions on weight management. Methods: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. Results: A total of 85.6% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (?581 vs ?82 kcal; P<.05), protein intake (?17 vs ?3 g; P<.05), fat intake (?8 vs 3 g; P<.05), and carbohydrate intake (?106.5 vs ?4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]?min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (?1.56 vs ?0.86 kg and ?1.56 vs ?0.66 kg, respectively; P<.05) and BMI (?0.61 vs ?0.33 kg/m2 and ?0.61 vs ?0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (?4.11 vs ?1.01 kg and ?4.11 vs ?0.83 kg, respectively; P<.05) and BMI (?1.61 vs ?0.40 kg/m2 and ?1.61 vs ?0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (?0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (?8.15 vs ?3.04 mmHg and ?8.15 vs ?3.80 mmHg, respectively; P<.05), triglyceride (?0.48 vs 0.11 mmol/L and ?0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (?0.77 vs 0.43 mmol/L and ?0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (?0.00 vs ?0.07 mmol/L; P<.05) and hemoglobin A1c (?0.19% vs ?0.07%; P<.05) between groups DPI and C. Conclusions: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976 UR - https://www.jmir.org/2023/1/e41926 UR - http://dx.doi.org/10.2196/41926 UR - http://www.ncbi.nlm.nih.gov/pubmed/37115608 ID - info:doi/10.2196/41926 ER - TY - JOUR AU - Tugault-Lafleur, N. Claire AU - De-Jongh González, Olivia AU - Macdonald, Janice AU - Bradbury, Jennifer AU - Warshawski, Tom AU - Ball, C. Geoff D. AU - Morrison, Katherine AU - Ho, Josephine AU - Hamilton, Jill AU - Buchholz, Annick AU - Mâsse, Louise PY - 2023/4/25 TI - Efficacy of the Aim2Be Intervention in Changing Lifestyle Behaviors Among Adolescents With Overweight and Obesity: Randomized Controlled Trial JO - J Med Internet Res SP - e38545 VL - 25 KW - mobile health KW - mHealth KW - childhood obesity KW - lifestyle management KW - adolescents KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. Objective: The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. Methods: A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents? assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. Results: A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. Conclusions: The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 UR - https://www.jmir.org/2023/1/e38545 UR - http://dx.doi.org/10.2196/38545 UR - http://www.ncbi.nlm.nih.gov/pubmed/37097726 ID - info:doi/10.2196/38545 ER - TY - JOUR AU - Keeble, Matthew AU - Adams, Jean AU - Burgoine, Thomas PY - 2023/4/17 TI - Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis JO - JMIR Public Health Surveill SP - e41822 VL - 9 KW - COVID-19 KW - digital food environment KW - fast foods KW - online food delivery services KW - public health N2 - Background: Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. Objective: We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. Methods: In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). Results: Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). Conclusions: The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health. UR - https://publichealth.jmir.org/2023/1/e41822 UR - http://dx.doi.org/10.2196/41822 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848236 ID - info:doi/10.2196/41822 ER - TY - JOUR AU - Tessier, Anne-Julie AU - Moyen, Audrey AU - Lawson, Claire AU - Rappaport, Ilysse Aviva AU - Yousif, Hiba AU - Fleurent-Grégoire, Chloé AU - Lalonde-Bester, Sophie AU - Brazeau, Anne-Sophie AU - Chevalier, Stéphanie PY - 2023/3/30 TI - Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 Pandemic: Results from the Canadian COVIDiet Online Cohort Study JO - JMIR Public Health Surveill SP - e43786 VL - 9 KW - healthy lifestyle KW - behaviors KW - pandemic KW - COVID-19 KW - public health KW - body image KW - gender KW - stress KW - risk factor KW - physical activity KW - mental well-being KW - depression N2 - Background: The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviors, including eating habits and physical activity; yet, few studies have identified the emerging patterns of such changes and associated risk factors. Objective: This study aims to identify the patterns of weight and lifestyle behavior changes, and the potential risk factors, resulting from the pandemic in Canadian adults. Methods: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1%, women; n=1316, 81.8%, White) of the Canadian COVIDiet study baseline data (May-December 2020). Self-reported current and prepandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake, and sleep quality were collected through online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behavior change patterns. Associations with potential risk factors, including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in the stress level, living situation, and work arrangement, were examined with logistic regressions. Results: Participants? mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 participants, 980 (60.9%) had a bachelor?s degree or above. Since the pandemic, 563 (35%) had decreased income and 788 (49%) changed their work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, and smoking and alcohol consumption, yet 708 (44%) reported a perceived decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior change emerged: healthy and less healthy (probability: 0.605 and 0.395, respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The healthy lifestyle behavior change group more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits, and increased physical activity. The less healthy lifestyle behavior change group reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction (odds ratio [OR] 8.8, 95% CI 5.3-14.7), depression (OR 1.8, 95% CI 1.3-2.5), increased stress level (OR 3.4, 95% CI 2.0-5.8), and gender minority identity (OR 5.5, 95% CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted models. Conclusions: The COVID-19 pandemic has appeared to have influenced lifestyle behaviors unfavorably in some but favorably in others. Body image perception, change in stress level, and gender identity are factors associated with behavior change patterns; whether these will sustain over time remains to be studied. Findings provide insights into developing strategies for supporting adults with poorer mental well-being in the postpandemic context and promoting healthful behaviors during future disease outbreaks. Trial Registration: ClinicalTrials.gov NCT04407533; https://clinicaltrials.gov/ct2/show/NCT04407533 UR - https://publichealth.jmir.org/2023/1/e43786 UR - http://dx.doi.org/10.2196/43786 UR - http://www.ncbi.nlm.nih.gov/pubmed/36848226 ID - info:doi/10.2196/43786 ER - TY - JOUR AU - Silva, Flávia AU - Rodrigues Amorim Adegboye, Amanda AU - Lachat, Carl AU - Curioni, Cintia AU - Gomes, Fabio AU - Collins, S. Gary AU - Kac, Gilberto AU - de Beyer, Anne Jennifer AU - Cook, Jonathan AU - Ismail, Cheikh Leila AU - Page, Matthew AU - Khandpur, Neha AU - Lamb, Sarah AU - Hopewell, Sally AU - Kirtley, Shona AU - Durão, Solange AU - Vorland, J. Colby AU - Schlussel, M. Michael PY - 2023/3/23 TI - Completeness of Reporting in Diet- and Nutrition-Related Randomized Controlled Trials and Systematic Reviews With Meta-Analysis: Protocol for 2 Independent Meta-Research Studies JO - JMIR Res Protoc SP - e43537 VL - 12 KW - nutrition KW - diet KW - randomized controlled trials KW - CONSORT KW - TIDieR KW - PRISMA KW - spin KW - risk KW - bias KW - research KW - intervention KW - literature KW - limitations KW - PubMed N2 - Background: Journal articles describing randomized controlled trials (RCTs) and systematic reviews with meta-analysis of RCTs are not optimally reported and often miss crucial details. This poor reporting makes assessing these studies? risk of bias or reproducing their results difficult. However, the reporting quality of diet- and nutrition-related RCTs and meta-analyses has not been explored. Objective: We aimed to assess the reporting completeness and identify the main reporting limitations of diet- and nutrition-related RCTs and meta-analyses of RCTs, estimate the frequency of reproducible research practices among these RCTs, and estimate the frequency of distorted presentation or spin among these meta-analyses. Methods: Two independent meta-research studies will be conducted using articles published in PubMed-indexed journals. The first will include a sample of diet- and nutrition-related RCTs; the second will include a sample of systematic reviews with meta-analysis of diet- and nutrition-related RCTs. A validated search strategy will be used to identify RCTs of nutritional interventions and an adapted strategy to identify meta-analyses in PubMed. We will search for RCTs and meta-analyses indexed in 1 calendar year and randomly select 100 RCTs (June 2021 to June 2022) and 100 meta-analyses (July 2021 to July 2022). Two reviewers will independently screen the titles and abstracts of records yielded by the searches, then read the full texts to confirm their eligibility. The general features of these published RCTs and meta-analyses will be extracted into a research electronic data capture database (REDCap; Vanderbilt University). The completeness of reporting of each RCT will be assessed using the items in the CONSORT (Consolidated Standards of Reporting Trials), its extensions, and the TIDieR (Template for Intervention Description and Replication) statements. Information about practices that promote research transparency and reproducibility, such as the publication of protocols and statistical analysis plans will be collected. There will be an assessment of the completeness of reporting of each meta-analysis using the items in the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement and collection of information about spin in the abstracts and full-texts. The results will be presented as descriptive statistics in diagrams or tables. These 2 meta-research studies are registered in the Open Science Framework. Results: The literature search for the first meta-research retrieved 20,030 records and 2182 were potentially eligible. The literature search for the second meta-research retrieved 10,918 records and 850 were potentially eligible. Among them, random samples of 100 RCTs and 100 meta-analyses were selected for data extraction. Data extraction is currently in progress, and completion is expected by the beginning of 2023. Conclusions: Our meta-research studies will summarize the main limitation on reporting completeness of nutrition- or diet-related RCTs and meta-analyses and provide comprehensive information regarding the particularities in the reporting of intervention studies in the nutrition field. International Registered Report Identifier (IRRID): DERR1-10.2196/43537 UR - https://www.researchprotocols.org/2023/1/e43537 UR - http://dx.doi.org/10.2196/43537 UR - http://www.ncbi.nlm.nih.gov/pubmed/36951931 ID - info:doi/10.2196/43537 ER - TY - JOUR AU - Rastmanesh, Reza AU - Flack, D. Kyle PY - 2023/3/3 TI - Dietary Temperature?s Influence on Energy Balance in Humans: Protocol for a Randomized Controlled Trial and Crossover Design JO - JMIR Res Protoc SP - e42846 VL - 12 KW - dietary temperature KW - energy intake KW - energy conservation KW - heat shock proteins KW - clinical trial KW - design of study N2 - Background: According to the first law of thermodynamics, energy cannot be created or destroyed in an isolated system. Water has a characteristically high heat capacity, indicating that the temperature of ingested fluids and meals could contribute to energy homeostasis. Citing the underlying molecular mechanisms, we present a novel hypothesis that states that the temperature of one?s food and drink contributes to energy balance and plays a role in the development of obesity. We provide strong associations with certain molecular mechanisms that are activated by heat and correlate them with obesity and a hypothetical trial that could test this hypothesis. We conclude that if meal or drink temperature proves to contribute to energy homeostasis, then depending on its contribution and scale, future clinical trials should attempt to adjust this effect when analyzing data. In addition, previous research and established relationships of disease states with dietary patterns, energy intake, and food component intakes should be revisited. We understand the common assumption that thermal energy in food is absorbed by the body during digestion and dissipated as heat into the environment, not contributing to the energy balance. We challenge this assumption herein, including a proposed study design that would test our hypothesis. Objective: This paper hypothesizes that the temperature of ingested foods or fluids influences energy homeostasis through the expression of heat shock proteins (HSPs), especially HSP-70 and HSP-90, which are expressed to a greater extent in obesity and are known to cause deficits in glucose metabolism. Methods: We provide preliminary evidence supporting our hypothesis that greater dietary temperatures disproportionally induce activation of both intracellular and extracellular HSPs and that these HSPs influence energy balance and contribute to obesity. Results: This trial protocol has not been initiated and funding has not been sought at the time of this publication. Conclusions: To date, no clinical trials are available regarding the potential effects of meal and fluid temperature on weight status or its confounding effects in data analysis. A potential mechanism is proposed as a basis by which higher temperatures of foods and beverages might influence energy balance via HSP expression. On the basis of the evidence supporting our hypothesis, we propose a clinical trial that will further elucidate these mechanisms. International Registered Report Identifier (IRRID): PRR1-10.2196/42846 UR - https://www.researchprotocols.org/2023/1/e42846 UR - http://dx.doi.org/10.2196/42846 UR - http://www.ncbi.nlm.nih.gov/pubmed/36867437 ID - info:doi/10.2196/42846 ER - TY - JOUR AU - Voss, Claire AU - Liu, Jianyi AU - Chang, Angela AU - Kosmas, A. Jacqueline AU - Biehl, Abigail AU - Flynn, L. Rebecca AU - Kruzan, P. Kaylee AU - Wildes, E. Jennifer AU - Graham, K. Andrea PY - 2023/2/28 TI - Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach JO - JMIR Form Res SP - e40506 VL - 7 KW - binge eating KW - weight loss expectations KW - overvaluation of weight and shape KW - digital intervention KW - human-centered design KW - weight loss KW - user expectations KW - behavioral change KW - eating disorder KW - obesity KW - overweight N2 - Background: People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. Objective: The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. Methods: A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Results: Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. Conclusions: In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals? intended treatment goals to facilitate engagement and successful outcomes in a digital intervention. UR - https://formative.jmir.org/2023/1/e40506 UR - http://dx.doi.org/10.2196/40506 UR - http://www.ncbi.nlm.nih.gov/pubmed/36853750 ID - info:doi/10.2196/40506 ER - TY - JOUR AU - Al-Shami, Islam AU - Al Hourani, Huda AU - Alkhatib, Buthaina AU - Alboqai, Omar AU - AlHalaika, Dima AU - Al-Jawaldeh, Ayoub PY - 2023/2/17 TI - Jordan?s Population-Based Food Consumption Survey: Protocol for Design and Development JO - JMIR Res Protoc SP - e41636 VL - 12 KW - household KW - food consumption KW - 24-hour dietary recall KW - children KW - adolescents KW - adults KW - older adults KW - overweight KW - obesity N2 - Background: One of the factors influencing health and well-being is dietary patterns. Data on food consumption are necessary for evaluating and developing community nutrition policies. Few studies on Jordanians? food consumption and dietary habits at various ages have been conducted, despite the increased prevalence of overweight, obesity, and chronic diseases. This will be the first study focusing on Jordanians? food consumption patterns that includes children, adolescents, adults, and older adults. Objective: This cross-sectional study aims to describe the design and methodology of the Jordan?s Population-based Food Consumption Survey, 2021-2022, which was developed to collect data on food consumption, including energy, nutrients, and food group intake, from a representative sample of Jordanians and to determine the prevalence of overweight and obesity and their relationship to food consumption. Methods: Participants were selected by stratified random sampling, using the Estimated Population of the Kingdom by Governorate, Locality, Sex, and Households, 2020 as the sampling frame. The food consumption survey sample was at the population level, representing gender and age classes (8-85 years old). The data collection period was 6 months. Food consumption was assessed using 24-hour dietary recall (2 nonconsecutive days, 1 week apart) interviews representing weekdays and weekends. In addition to data on food consumption, information on the use of food supplements, sociodemographic and socioeconomic status, and health was gathered. Weight, height, and waist circumference were all measured. Results: The survey included 632 households with 2145 participants, of which 243 (11.3%) were children, 374 (17.4%) were adolescents, 1428 (66.6%) were adults, and 99 (4.6%) were older adults. Three food consumption databases were used to stratify the mean 24-hour dietary recall food consumption into energy intake, carbohydrates, proteins, fats, fiber, vitamins and minerals, and food groups. BMI was calculated and classified as normal, overweight, or obese. Central obesity was classified as normal or abnormal based on the waist-to-height ratio. The survey results will be disseminated based on age, energy, nutrient, and food group consumption. The prevalence of overweight and obesity by age group will be presented, as well as a comparison to the situation in Eastern Mediterranean countries. Conclusions: The survey data will be helpful in nutritional studies, assessing changes in dietary patterns, and developing and evaluating nutrition or health policies. It will be a solid base for developing a future national surveillance system on food consumption patterns with comprehensive food consumption, physical activity, biochemical, and blood pressure data. International Registered Report Identifier (IRRID): DERR1-10.2196/41636 UR - https://www.researchprotocols.org/2023/1/e41636 UR - http://dx.doi.org/10.2196/41636 UR - http://www.ncbi.nlm.nih.gov/pubmed/36800239 ID - info:doi/10.2196/41636 ER - TY - JOUR AU - Jayasinghe, Sisitha AU - Holloway, P. Timothy AU - Soward, Robert AU - Patterson, E. Kira A. AU - Ahuja, K. Kiran D. AU - Dalton, Lisa AU - Murray, Sandra AU - Hughes, Roger AU - Byrne, M. Nuala AU - Hills, P. Andrew PY - 2023/2/17 TI - ?An Ounce of Prevention is Worth a Pound of Cure?: Proposal for a Social Prescribing Strategy for Obesity Prevention and Improvement in Health and Well-being JO - JMIR Res Protoc SP - e41280 VL - 12 KW - capacity building KW - community development KW - determinants of health KW - health care delivery KW - health care management KW - obese KW - obesity KW - patient education KW - peer education KW - prevention KW - screening KW - service delivery KW - social prescribing KW - social prescription KW - weight N2 - Background: Social and behavioral determinants of health are increasingly recognized as central to effective person-centered intervention in clinical practice, disease management, and public health. Accordingly, social prescribing (SP) has received increased attention in recent times. The rampant global prevalence of obesity indicates that the customary, reductionistic, and disease-oriented biomedical approach to health service delivery is inadequate/ineffective at arresting the spread and mitigating the damaging consequences of the condition. There is an urgent need to shift the focus from reactive downstream disease-based treatments to more proactive, upstream, preventive action. In essence, this requires more effort to affect the paradigm shift from the traditional ?biomedical approach of care? to a ?biopsychosocial model? required to arrest the increasing prevalence of obesity. To this end, an SP approach, anchored in systems thinking, could be an effective means of moderating prevalence and consequences of obesity at a community level. Objective: The proposed SP intervention has the following three key objectives: (1) build a sustainable program for Circular Head based on SP, peer education, and health screening to minimize the incidence of obesity and related lifestyle diseases; (2) increase service and workforce connectivity and collaboration and initiate the introduction of new services and activities for obesity prevention and community health promotion; and (3) enhance health and well-being and minimize preventable adverse health outcomes of obesity and related lifestyle diseases through enhancement of food literacy and better nutrition, enhancement of physical literacy and habitual personal activity levels, and improvement of mental health, community connectedness, and reduction of social isolation. Methods: This paper describes a prospective SP strategy aimed at obesity prevention in Circular Head, a local government area in Northwest (NW) Tasmania. SP is a prominent strategy used in the Critical Age Periods Impacting the Trajectory of Obesogenic Lifestyles Project, which is an initiative based in NW Tasmania focused on assessing obesity prevention capacity. A social prescription model that facilitates the linkage of primary health screening with essential health care, education, and community resources through a dedicated ?navigator? will be implemented. Four interlinked work packages will be implemented as part of the initial plan with each either building on existing resources or developing new initiatives. Results: A multimethod approach to triangulate insights from quantitative and qualitative research that enables the assessment of impact on individuals, community groups, and the health care system will be implemented within the initial pilot phase of the project. Conclusions: Literature is replete with rhetoric advocating complex system approaches to curtail obesity. However, real-life examples of whole-of-systems interventions operationalized in ways that generate relevant evidence or effective policies are rare. The diverse approach for primary prevention of obesity-related lifestyle diseases and strategies for improvement of health and well-being described in this instance will contribute toward closing this evidence gap. International Registered Report Identifier (IRRID): PRR1-10.2196/41280 UR - https://www.researchprotocols.org/2023/1/e41280 UR - http://dx.doi.org/10.2196/41280 UR - http://www.ncbi.nlm.nih.gov/pubmed/36800232 ID - info:doi/10.2196/41280 ER - TY - JOUR AU - Chiarello, Indira Delia AU - Pardo, Fabian AU - Moya, Jessica AU - Pino, Maricela AU - Rodríguez, Andrea AU - Araneda, Eugenia María AU - Bertini, Ayleen AU - Gutiérrez, Jaime PY - 2023/2/15 TI - An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e44456 VL - 12 KW - gestational obesity KW - mHealth KW - primary care KW - randomized controlled trial N2 - Background: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. Objective: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. Methods: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. Results: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. Conclusions: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. Trial Registration: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174 International Registered Report Identifier (IRRID): DERR1-10.2196/44456 UR - https://www.researchprotocols.org/2023/1/e44456 UR - http://dx.doi.org/10.2196/44456 UR - http://www.ncbi.nlm.nih.gov/pubmed/36790846 ID - info:doi/10.2196/44456 ER - TY - JOUR AU - Gilano, Girma AU - Hailegebreal, Samuel AU - Sako, Sewunet AU - Haile, Firehiwot AU - Gilano, Kasarto AU - Seboka, Tariku Binyam AU - Kashala, Kefita PY - 2023/2/8 TI - Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models JO - JMIR Public Health Surveill SP - e39744 VL - 9 KW - wasting KW - Generalized Linear Latent and Mixed Models KW - GLLAMM KW - under-five children KW - factors KW - Ethiopia N2 - Background: Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. Objective: This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. Methods: We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model?s assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. Results: In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ?6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (?40.40, 95% CI ?40.41 to ?40.32), home delivery (?35.51, 95% CI ?35.55 to ?35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (?12.65, 95% CI ?12.69 to ?12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). Conclusions: According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services. UR - https://publichealth.jmir.org/2023/1/e39744 UR - http://dx.doi.org/10.2196/39744 UR - http://www.ncbi.nlm.nih.gov/pubmed/36753309 ID - info:doi/10.2196/39744 ER - TY - JOUR AU - Wang, Kai AU - Xia, Fang AU - Li, Qingwen AU - Luo, Xin AU - Wu, Jinyi PY - 2023/1/11 TI - The Associations of Weekend Warrior Activity Patterns With the Visceral Adiposity Index in US Adults: Repeated Cross-sectional Study JO - JMIR Public Health Surveill SP - e41973 VL - 9 KW - weekend warrior KW - Visceral Adiposity Index KW - NHANES KW - physical activity KW - obesity N2 - Background: According to previous reports, obesity especially visceral fat has become an important public health problem, causing an estimation of 20.5 disability-adjusted life years per 1000 inhabitants. Those who exercised for 1 or 2 days per week and reached the recommended 150 minutes of moderate physical activity (PA) per week have been defined as ?weekend warriors? (WWs). Although the benefits of PA in suppressing obesity have been widely studied, the association of WWs with the Visceral Adiposity Index (VAI) and the difference between WW activity and regular PA are yet to be explored. Objective: This study aims to explore the association between WW activity and other PA patterns with VAI in US adults. Methods: The National Health and Nutrition Examination Survey 2007-2016 data set was used, and the analytic sample was limited to adults 20 years and older who had complete information about VAI, PA patterns, and other covariates, including demographic characteristics, behavioral factors, and disease conditions. Participants? characteristics in different PA pattern groups were tested using the Rao and Scott adjusted ?2 test and ANOVA. Univariate and multivariate stepped linear regression models were then used to explore the association between the PA pattern and VAI. Finally, stratified analyses and interaction effects were conducted to investigate whether the association was stable among subgroups. Results: The final sample included 9642 adults 20 years or older, which is representative of 158.1 million noninstitutionalized US adults, with 52.15% (n=5169) being male and 70.8% (n=4443) being non-Hispanic White. Gender, age group, race, education level, income level, marital status, smoking status, alcoholism, VAI, cardiovascular disease, and diabetes were all correlated with the PA pattern, but no relationship between hypertension and PA pattern was observed. After adjusting for demographic covariates, smoking status, alcoholism, cardiovascular disease, diabetes, and hypertension, WW and regularly active adults had a ? of .307 (95% CI ?0.611 to ?0.003) and .354 (95% CI ?0.467 to ?0.241), respectively, for reduced VAI when compared with inactive adults, but no significant effect of lowering VAI (?=?.132, 95% CI ?0.282 to 0.018) was observed in insufficiently active adults when compared with inactive adults. Besides, no significant difference was exhibited between WW adults and regularly active adults (?=.047, 95% CI ?0.258 to 0.352), suggesting WW adults had the same benefit of decreasing VAI as regularly active adults. Stratified analyses results exhibited that WW activity was related to reduced VAI in female adults aged 20-44 years who were non-Hispanic Black, other, or multiracial; high school or General Educational Development education; and never married, and the association between PA pattern and VAI remained stable in all demographic subgroups. Conclusions: Compared with inactive adults, WWs could reduce VAI, and there was no significant difference between WWs and regular active adults in decreasing VAI. Our study provides compelling evidence of the beneficial effect of WW activity on visceral obesity. UR - https://publichealth.jmir.org/2023/1/e41973 UR - http://dx.doi.org/10.2196/41973 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630179 ID - info:doi/10.2196/41973 ER - TY - JOUR AU - Li, Sixuan AU - Wang, Yong AU - Ying, Yanyan AU - Gong, Qinghai AU - Lou, Ge AU - Liu, Yang AU - Liu, Shiwei AU - Li, Hui PY - 2023/1/11 TI - Independent and Joint Associations of BMI and Waist Circumference With the Onset of Type 2 Diabetes Mellitus in Chinese Adults: Prospective Data Linkage Study SP - e39459 VL - 9 KW - body mass index KW - waist circumference KW - type 2 diabetes mellitus KW - prospective study KW - data linkage KW - epidemiology KW - hazard ratio N2 - Background: General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial. Objective: The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions. Methods: A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants? identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression. Results: In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825). Conclusions: Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM. UR - https://publichealth.jmir.org/2023/1/e39459 UR - http://dx.doi.org/10.2196/39459 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630180 ID - info:doi/10.2196/39459 ER - TY - JOUR AU - Patel, L. Michele AU - Cleare, E. Angel AU - Smith, M. Carly AU - Rosas, Goldman Lisa AU - King, C. Abby PY - 2022/12/13 TI - Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study JO - JMIR Form Res SP - e42191 VL - 6 IS - 12 KW - weight loss KW - obesity KW - behavioral intervention KW - self-monitoring KW - race KW - ethnicity KW - digital health KW - diet tracking KW - engagement KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. Objective: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. Methods: We recruited racial and ethnic minority adults aged ?21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants? homes and reported descriptively. Results: The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was ?3.4 (95% CI ?4.6 to ?2.2) kg for detailed and ?3.3 (95% CI ?4.4 to ?2.2) kg for simplified. Conclusions: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. Trial Registration: ASPREDICTED #66674; https://aspredicted.org/ka478.pdf UR - https://formative.jmir.org/2022/12/e42191 UR - http://dx.doi.org/10.2196/42191 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512404 ID - info:doi/10.2196/42191 ER - TY - JOUR AU - An, Ruopeng AU - Shen, Jing AU - Xiao, Yunyu PY - 2022/12/7 TI - Applications of Artificial Intelligence to Obesity Research: Scoping Review of Methodologies JO - J Med Internet Res SP - e40589 VL - 24 IS - 12 KW - artificial intelligence KW - deep learning KW - machine learning KW - obesity KW - scoping review N2 - Background: Obesity is a leading cause of preventable death worldwide. Artificial intelligence (AI), characterized by machine learning (ML) and deep learning (DL), has become an indispensable tool in obesity research. Objective: This scoping review aimed to provide researchers and practitioners with an overview of the AI applications to obesity research, familiarize them with popular ML and DL models, and facilitate the adoption of AI applications. Methods: We conducted a scoping review in PubMed and Web of Science on the applications of AI to measure, predict, and treat obesity. We summarized and categorized the AI methodologies used in the hope of identifying synergies, patterns, and trends to inform future investigations. We also provided a high-level, beginner-friendly introduction to the core methodologies to facilitate the dissemination and adoption of various AI techniques. Results: We identified 46 studies that used diverse ML and DL models to assess obesity-related outcomes. The studies found AI models helpful in detecting clinically meaningful patterns of obesity or relationships between specific covariates and weight outcomes. The majority (18/22, 82%) of the studies comparing AI models with conventional statistical approaches found that the AI models achieved higher prediction accuracy on test data. Some (5/46, 11%) of the studies comparing the performances of different AI models revealed mixed results, indicating the high contingency of model performance on the data set and task it was applied to. An accelerating trend of adopting state-of-the-art DL models over standard ML models was observed to address challenging computer vision and natural language processing tasks. We concisely introduced the popular ML and DL models and summarized their specific applications in the studies included in the review. Conclusions: This study reviewed AI-related methodologies adopted in the obesity literature, particularly ML and DL models applied to tabular, image, and text data. The review also discussed emerging trends such as multimodal or multitask AI models, synthetic data generation, and human-in-the-loop that may witness increasing applications in obesity research. UR - https://www.jmir.org/2022/12/e40589 UR - http://dx.doi.org/10.2196/40589 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476515 ID - info:doi/10.2196/40589 ER - TY - JOUR AU - Wong, Eiin Jyh AU - Yamaguchi, Miwa AU - Nishi, Nobuo AU - Araki, Michihiro AU - Wee, Hum Lei PY - 2022/12/7 TI - Predicting Overweight and Obesity Status Among Malaysian Working Adults With Machine Learning or Logistic Regression: Retrospective Comparison Study JO - JMIR Form Res SP - e40404 VL - 6 IS - 12 KW - overweight KW - obesity KW - prediction KW - machine learning KW - logistic regression KW - etiology KW - algorithms KW - Malaysia KW - adults KW - predictive models KW - accuracy KW - working adults KW - surveillance N2 - Background: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status. Objective: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia. Methods: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41% male; n=7048, 41.8% with overweight or obesity) in the Malaysia?s Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2. Results: The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79-0.82), 0.80 (95% CI 0.79-0.81), 0.80 (95% CI 0.78-0.81), and 0.78 (95% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models. Conclusions: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia. UR - https://formative.jmir.org/2022/12/e40404 UR - http://dx.doi.org/10.2196/40404 UR - http://www.ncbi.nlm.nih.gov/pubmed/36476813 ID - info:doi/10.2196/40404 ER - TY - JOUR AU - Hermsen, Sander AU - van Kraaij, Alex AU - Camps, Guido PY - 2022/12/2 TI - Low? and Medium?Socioeconomic-Status Group Members? Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study JO - JMIR Hum Factors SP - e40123 VL - 9 IS - 4 KW - nutrition KW - citizen science KW - socioeconomic status KW - digital technology N2 - Background: Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users? needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. Objective: This study aimed to gather insights into people?s thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Methods: Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. Results: A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. Conclusions: This study shows that people from low? and medium?socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this. UR - https://humanfactors.jmir.org/2022/4/e40123 UR - http://dx.doi.org/10.2196/40123 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459403 ID - info:doi/10.2196/40123 ER - TY - JOUR AU - Wray, Bridget AU - Grimes, Amanda AU - Eighmy, Katlyn AU - Lightner, Joseph PY - 2022/11/23 TI - The Relationship Between Social Integration and Physical Activity, Diet, and Sleep Among Youths: Cross-sectional Survey Study JO - JMIR Pediatr Parent SP - e40354 VL - 5 IS - 4 KW - social integration KW - youth KW - nutrition KW - sleep KW - physical activity KW - adults KW - exercise KW - health KW - wellness KW - health behavior KW - school students KW - diet KW - children KW - health behavior intervention N2 - Background: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. Objective: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. Methods: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. Results: Time with friends significantly predicted moderate to vigorous intensity PA (?=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). Conclusions: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths? health behaviors. International Registered Report Identifier (IRRID): RR2-10.2196/37126 UR - https://pediatrics.jmir.org/2022/4/e40354 UR - http://dx.doi.org/10.2196/40354 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416871 ID - info:doi/10.2196/40354 ER - TY - JOUR AU - Soltero, G. Erica AU - Lopez, Callie AU - Hernandez, Edith AU - O'Connor, M. Teresia AU - Thompson, Debbe PY - 2022/11/4 TI - Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review JO - JMIR Pediatr Parent SP - e39261 VL - 5 IS - 4 KW - obesity KW - technology KW - adolescents KW - health disparities KW - prevention interventions KW - prevention KW - intervention KW - feasibility KW - effectiveness KW - Hispanic KW - engagement N2 - Background: Given that today?s adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. Objective: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. Methods: A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. Results: Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health. Conclusions: To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. Trial Registration: CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442 UR - https://pediatrics.jmir.org/2022/4/e39261 UR - http://dx.doi.org/10.2196/39261 UR - http://www.ncbi.nlm.nih.gov/pubmed/36331547 ID - info:doi/10.2196/39261 ER - TY - JOUR AU - Tsai, A. Krystle AU - Cassidy, Omni AU - Arshonsky, Josh AU - Bond, Sara AU - Del Giudice, M. Inés AU - Bragg, A. Marie PY - 2022/10/14 TI - COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis JO - JMIR Form Res SP - e37642 VL - 6 IS - 10 KW - COVID-19 KW - food and beverage marketing KW - Twitter KW - obesity KW - social media KW - nutrition KW - risk factor KW - health advertising KW - marketing N2 - Background: Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. Objective: We aimed to document the types and frequencies of COVID-19?related themes in US food and beverage companies? Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets. Methods: Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and ?retweets?; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content. Results: Our final sample included 874 COVID-19?themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products. Conclusions: Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19. UR - https://formative.jmir.org/2022/10/e37642 UR - http://dx.doi.org/10.2196/37642 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040957 ID - info:doi/10.2196/37642 ER - TY - JOUR AU - Garcia, O. David AU - Valdez, A. Luis AU - Aceves, Benjamin AU - Bell, L. Melanie AU - Rabe, A. Brooke AU - Villavicencio, A. Edgar AU - Marrero, G. David AU - Melton, Forest AU - Hooker, P. Steven PY - 2022/9/21 TI - mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study JO - JMIR Form Res SP - e37637 VL - 6 IS - 9 KW - Hispanic KW - mobile health KW - mHealth KW - overweight KW - obesity KW - weight loss N2 - Background: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. Objective: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. Methods: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ?225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants? weight loss experiences and perspectives on mHealth technologies. Results: Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was ?4.7 kg (95% CI 7.1 to ?2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. Conclusions: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. Trial Registration: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521 UR - https://formative.jmir.org/2022/9/e37637 UR - http://dx.doi.org/10.2196/37637 UR - http://www.ncbi.nlm.nih.gov/pubmed/36129735 ID - info:doi/10.2196/37637 ER - TY - JOUR AU - Huang, Yuru AU - Burgoine, Thomas AU - Essman, Michael AU - Theis, Z. Dolly R. AU - Bishop, P. Tom R. AU - Adams, Jean PY - 2022/9/8 TI - Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study JO - JMIR Public Health Surveill SP - e39033 VL - 8 IS - 9 KW - nutritional database KW - web scraping KW - food prepared out of the home KW - out-of-home KW - data science KW - chains N2 - Background: Hand transcribing nutrient composition data from websites requires extensive human resources and is prone to error. As a result, there are limited nutrient composition data on food prepared out of the home in the United Kingdom. Such data are crucial for understanding and monitoring the out-of-home food environment, which aids policy making. Automated data collection from publicly available sources offers a potential low-resource solution to address this gap. Objective: In this paper, we describe the first UK longitudinal nutritional database of food prepared out of the home, MenuTracker. As large chains will be required to display calorie information on their UK menus from April 2022, we also aimed to identify which chains reported their nutritional information online in November 2021. In a case study to demonstrate the utility of MenuTracker, we estimated the proportions of menu items exceeding recommended energy and nutrient intake (eg, >600 kcal per meal). Methods: We have collated nutrient composition data of menu items sold by large chain restaurants quarterly since March 2021. Large chains were defined as those with 250 employees or more (those covered by the new calorie labeling policy) or belonging to the top 100 restaurants based on sales volume. We developed scripts in Python to automate the data collection process from business websites. Various techniques were used to harvest web data and extract data from nutritional tables in PDF format. Results: Automated Python programs reduced approximately 85% of manual work, totaling 500 hours saved for each wave of data collection. As of January 2022, MenuTracker has 76,405 records from 88 large out-of-home food chains at 4 different time points (ie, March, June, September, and December) in 2021. In constructing the database, we found that one-quarter (24.5%, 256/1043) of large chains, which are likely to be subject to the United Kingdom?s calorie menu labeling regulations, provided their nutritional information online in November 2021. Across these chains, 24.7% (16,391/66,295) of menu items exceeded the UK government?s recommendation of a maximum of 600 kcal for a single meal. Comparable figures were 46.4% (29,411/63,416) for saturated fat, 34.7% (21,964/63,388) for total fat, 17.6% (11,260/64,051) for carbohydrates, 17.8% (11,434/64,059) for sugar, and 35.2% (22,588/64,086) for salt. Furthermore, 0.7% to 7.1% of the menu items exceeded the maximum daily recommended intake for these nutrients. Conclusions: MenuTracker is a valuable resource that harnesses the power of data science techniques to use publicly available data online. Researchers, policy makers, and consumers can use MenuTracker to understand and assess foods available from out-of-home food outlets. The methods used in development are available online and can be used to establish similar databases elsewhere. UR - https://publichealth.jmir.org/2022/9/e39033 UR - http://dx.doi.org/10.2196/39033 UR - http://www.ncbi.nlm.nih.gov/pubmed/36074559 ID - info:doi/10.2196/39033 ER - TY - JOUR AU - Lopez, Virginia Nanette AU - Lai, HC Mark AU - Yang, Chih-Hsiang AU - Dunton, Fridlund Genevieve AU - Belcher, Ryan Britni PY - 2022/8/10 TI - Associations of Maternal and Paternal Parenting Practices With Children?s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study JO - JMIR Form Res SP - e38326 VL - 6 IS - 8 KW - parenting KW - ecological momentary assessment KW - fruit and vegetable consumption KW - physical activity KW - pediatrics KW - obesity N2 - Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers? weight-related (ie, diet and physical activity) parenting practices contribute to children?s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers? and mothers? weight-related parenting practices on children?s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child?s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children?s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (?=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (?=1.50, 95% CI ?0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (?=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (?=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children?s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers? and fathers? weight-related parenting practices on child?s obesogenic behaviors. UR - https://formative.jmir.org/2022/8/e38326 UR - http://dx.doi.org/10.2196/38326 UR - http://www.ncbi.nlm.nih.gov/pubmed/35947425 ID - info:doi/10.2196/38326 ER - TY - JOUR AU - Brakefield, S. Whitney AU - Olusanya, A. Olufunto AU - Shaban-Nejad, Arash PY - 2022/8/9 TI - Association Between Neighborhood Factors and Adult Obesity in Shelby County, Tennessee: Geospatial Machine Learning Approach JO - JMIR Public Health Surveill SP - e37039 VL - 8 IS - 8 KW - obesity KW - obesity surveillance KW - disease surveillance KW - machine learning KW - geographic information systems KW - social determinants of health KW - SDOH KW - disparities N2 - Background: Obesity is a global epidemic causing at least 2.8 million deaths per year. This complex disease is associated with significant socioeconomic burden, reduced work productivity, unemployment, and other social determinants of health (SDOH) disparities. Objective: The objective of this study was to investigate the effects of SDOH on obesity prevalence among adults in Shelby County, Tennessee, the United States, using a geospatial machine learning approach. Methods: Obesity prevalence was obtained from the publicly available 500 Cities database of Centers for Disease Control and Prevention, and SDOH indicators were extracted from the US census and the US Department of Agriculture. We examined the geographic distributions of obesity prevalence patterns, using Getis-Ord Gi* statistics and calibrated multiple models to study the association between SDOH and adult obesity. Unsupervised machine learning was used to conduct grouping analysis to investigate the distribution of obesity prevalence and associated SDOH indicators. Results: Results depicted a high percentage of neighborhoods experiencing high adult obesity prevalence within Shelby County. In the census tract, the median household income, as well as the percentage of individuals who were Black, home renters, living below the poverty level, 55 years or older, unmarried, and uninsured, had a significant association with adult obesity prevalence. The grouping analysis revealed disparities in obesity prevalence among disadvantaged neighborhoods. Conclusions: More research is needed to examine links between geographical location, SDOH, and chronic diseases. The findings of this study, which depict a significantly higher prevalence of obesity within disadvantaged neighborhoods, and other geospatial information can be leveraged to offer valuable insights, informing health decision-making and interventions that mitigate risk factors of increasing obesity prevalence. UR - https://publichealth.jmir.org/2022/8/e37039 UR - http://dx.doi.org/10.2196/37039 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943795 ID - info:doi/10.2196/37039 ER - TY - JOUR AU - Waselewski, Marika AU - Plegue, Melissa AU - Sonneville, Kendrin AU - Resnicow, Ken AU - Ghumman, Aisha AU - Ebbeling, Cara AU - Mahmoudi, Elham AU - Sen, Ananda AU - Wolfson, A. Julia AU - Chang, Tammy PY - 2022/8/5 TI - Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e40568 VL - 11 IS - 8 KW - pregnancy KW - weight KW - diet KW - grocery delivery N2 - Background: Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease. Objective: This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants. Methods: A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment. Results: This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026. Conclusions: This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health. Trial Registration: ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645 International Registered Report Identifier (IRRID): DERR1-10.2196/40568 UR - https://www.researchprotocols.org/2022/8/e40568 UR - http://dx.doi.org/10.2196/40568 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930351 ID - info:doi/10.2196/40568 ER - TY - JOUR AU - Abdullah, Rifham Shazana AU - Azizul, Hayati Nur AU - Wan Mohd Zin, Mona Ruziana AU - Sulaiman, Suffia Nur AU - Mustafa Khalid, Norhayati AU - Mohd Salim Mullahi Jahn, Jahn Roshan AU - Khalil, Nazrin Muhamad Khairul AU - Abu Seman, Norhashimah AU - Zainal Abidin, Azlin Nur AU - Ali, Azizan AU - Tan, Zhuan You AU - Omar, Azahadi AU - Johari, Zabri Mohammad AU - Abdul Aziz, Shahida Nur AU - Baharudin, Azli AU - Seman, Zamtira AU - Ibrahim Wong, Norazizah AU - Md Rasip, Lisa Mona AU - Yusof, Mohd Hayati AU - Md Noh, Fairulnizal Mohd PY - 2022/8/5 TI - Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting Among Civil Servants With Overweight and Obesity: Study Protocol for a Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e33801 VL - 11 IS - 8 KW - intermittent fasting KW - dry fasting KW - obesity KW - overweight KW - healthy plate N2 - Background: Overweight and obesity among adults are a growing global public health threat and an essential risk factor for various noncommunicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practiced worldwide, the effectiveness of 2 days per week dry fasting remains unclear. Objective: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study aims to determine the cardiometabolic, anthropometric, dietary intake, and quality of life changes among civil servants with overweight and obesity, following combined intermittent fasting and healthy plate (IFHP) and healthy plate (HP) and explore the participants? experiences. Methods: We designed a mixed methods quasi-experimental study to evaluate the effectiveness of the IFHP and HP methods among adults with overweight and obesity. A total of 177 participants were recruited for this study, of which 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) to the HP group. The intervention comprised 2 phases: supervised (12 weeks) and unsupervised (12 weeks). Data collection was conducted at baseline, after the supervised phase (week 12), and after the unsupervised phase (week 24). Serum and whole blood samples were collected from each participant for analysis. Data on sociodemographic factors, quality of life, physical activity, and dietary intake were also obtained using questionnaires during data collection. Results: Most of the participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). The expected outcomes of this study are changes in body weight, body composition, quality of life, physical activity, dietary intake, and cardiometabolic parameters such as fasting blood glucose, 2-hour postprandial blood glucose, hemoglobin A1c, fasting insulin, and lipid profile. Conclusions: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study is a mixed methods study to evaluate the effectiveness of combined IFHP and HP interventions on cardiometabolic and anthropometric parameters and explore participants? experiences throughout the study. Trial Registration: ClinicalTrials.gov NCT05034653; https://clinicaltrials.gov/ct2/show/NCT05034653 International Registered Report Identifier (IRRID): RR1-10.2196/33801 UR - https://www.researchprotocols.org/2022/8/e33801 UR - http://dx.doi.org/10.2196/33801 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930331 ID - info:doi/10.2196/33801 ER - TY - JOUR AU - Kaiser, Birgit AU - Stelzl, Tamara AU - Finglas, Paul AU - Gedrich, Kurt PY - 2022/8/4 TI - The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users? Experiences JO - JMIR Form Res SP - e34497 VL - 6 IS - 8 KW - Food Frequency Questionnaire KW - dietary assessment KW - Diet Quality Score KW - web application KW - digital nutrition KW - personalized nutrition KW - system usability KW - internet KW - eNutri KW - EIT Food Quisper N2 - Background: To address the epidemic burden of diet-related diseases, adequate dietary intake assessments are needed to determine the actual nutrition intake of a population. In this context, the eNutri web app has been developed, providing online automated personalized dietary advice, based on nutritional information recorded via an integrated and validated food frequency questionnaire (FFQ). Originally developed for a British population and their dietary habits, the eNutri tool has specifically been adapted to the German population, taking into account national eating habits and dietary recommendations. Objective: The primary aim of this study is to evaluate the system usability and users? experience and feedback on the eNutri app in a small-scale preliminary study. The secondary aim is to investigate the efficacy of personalized nutrition (PN) recommendations versus general dietary advice in altering eating habits. Methods: The app was piloted for 4 weeks by 106 participants from across Germany divided into a PN group and a control group. The groups differed according to the degree of personalization of dietary recommendations obtained. Results: An overall System Usability Scale (SUS) score of 78.4 (SD 12.2) was yielded, indicating an above average user experience. Mean completion time of the FFQ was 26.7 minutes (SD 10.6 minutes). Across subgroups (age, sex, device screen sizes) no differences in SUS or completion time were found, indicating an equal performance for all users independent of the assigned experimental group. Participants? feedback highlighted the need for more personalized dietary advice for controls, while personalized nutritional recommendations improved the awareness of healthy eating behavior. Further improvements to the eNutri app were suggested by the app users. Conclusions: In total, the eNutri app has proven to be a suitable instrument to capture the dietary habits of a German population sample. Regarding functionality, system usability, and handling, direct user feedback was quite positive. Nutritional advice given was rated ambivalent, pointing to several weaknesses in the eNutri app, minimizing the system?s full potential. A higher level of personalization within nutritional advice subjectively improved the app?s usability. The insights gained will be used as a basis to further develop and improve this digital diet assessment tool. UR - https://formative.jmir.org/2022/8/e34497 UR - http://dx.doi.org/10.2196/34497 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925664 ID - info:doi/10.2196/34497 ER - TY - JOUR AU - Tay, Wesley AU - Quek, Rina AU - Kaur, Bhupinder AU - Lim, Joseph AU - Henry, Jeyakumar Christiani PY - 2022/7/18 TI - Use of Facial Morphology to Determine Nutritional Status in Older Adults: Opportunities and Challenges JO - JMIR Public Health Surveill SP - e33478 VL - 8 IS - 7 KW - malnutrition KW - facial recognition KW - facial morphology KW - telemonitoring KW - 3D scans KW - digital health KW - digital nutrition KW - public health nutrition KW - mobile phone UR - https://publichealth.jmir.org/2022/7/e33478 UR - http://dx.doi.org/10.2196/33478 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849429 ID - info:doi/10.2196/33478 ER - TY - JOUR AU - Shinto, Takae AU - Makino, Saneyuki AU - Tahara, Yu AU - Nitta, Lyie AU - Kuwahara, Mai AU - Tada, Ayako AU - Abe, Nanako AU - Michie, Mikiko AU - Shibata, Shigenobu PY - 2022/7/12 TI - Relationship Between Protein Intake in Each Traditional Meal and Physical Activity: Cross-sectional Study JO - JMIR Public Health Surveill SP - e35898 VL - 8 IS - 7 KW - protein KW - dietary pattern KW - physical activity KW - chrononutrition N2 - Background: Protein intake plays an important role in the synthesis and maintenance of skeletal muscles for the prevention of health risks. It is also widely known that physical activity influences muscle function. However, no large-scale studies have examined the relationship between daily dietary habits, especially the timing of protein intake, and daily physical activity. Objective: The purpose of this cross-sectional study was to investigate how protein intake and composition (involving the 3 major nutrients protein, fat, and carbohydrate) in the 3 traditional meals (breakfast, lunch, and dinner) are associated with physical activity. Methods: Using daily dietary data accumulated in the smartphone food log app ?Asken? and a web-based cross-sectional survey involving Asken users (N=8458), we analyzed nutrient intake and composition, as well as daily activity levels. As very few individuals skipped breakfast (1102/19,319 responses, 5.7%), we analyzed data for 3 meals per day. Results: Spearman rank correlation analysis revealed that breakfast and lunch protein intakes had higher positive correlations with daily physical activity among the 3 major macronutrients (P<.001). These findings were confirmed by multivariate logistic regression analysis with confounding factors. Moreover, participants with higher protein intake and composition at breakfast or lunch tended to exhibit significantly greater physical activity than those with higher protein intake at dinner (P<.001). Conclusions: Among the 3 macronutrients, protein intake during breakfast and lunch was closely associated with daily physical activity. UR - https://publichealth.jmir.org/2022/7/e35898 UR - http://dx.doi.org/10.2196/35898 UR - http://www.ncbi.nlm.nih.gov/pubmed/35819831 ID - info:doi/10.2196/35898 ER - TY - JOUR AU - Liu, Sam AU - Smith, Nicholas AU - Nuss, Kayla AU - Perdew, Megan AU - Adiputranto, Dimas AU - Naylor, Patti-Jean PY - 2022/7/5 TI - Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention JO - JMIR Pediatr Parent SP - e36770 VL - 5 IS - 3 KW - engagement KW - dose response KW - childhood obesity KW - web-based intervention KW - child KW - obesity KW - weight KW - web based KW - intervention KW - family KW - families KW - lifestyle KW - parent KW - parental support KW - healthy eating KW - family support KW - physical activity KW - diet KW - exercise KW - fitness KW - online portal N2 - Background: The Early Intervention Program (EIP) was a 10-week, blended, in-person and online lifestyle intervention for families with children who were off the healthy weight trajectory. The engagement pattern and the dose response of EIP have not been examined. Objective: The aims of this paper are to examine families? engagement patterns with the EIP and to evaluate the dose-response relationship between EIP engagement patterns and physical activity and healthy eating?related outcomes at 10 weeks. Methods: Families with children (8-12 years old) who are off the healthy weight trajectory (child BMI ?85th percentile for age and sex) were recruited. Pre- and postintervention questionnaires assessed child lifestyle behaviors, parental support behaviors, family lifestyle habits, as well as parental physical activity and healthy-eating identity. Hierarchical cluster analysis of both in-person and online components was used to classify engagement patterns. Regression analysis assessed differences in outcomes by engagement groups. Results: Two distinct clusters of engagement groups were identified (N=66), which were in-person (IP; n=40, 61%) and in-person + online (IP+; n=26, 39%) engagement. Relative to the IP group at week 10, IP+ showed a greater child moderate-to-vigorous physical activity level (1.53, SD 0.56; P=.008), child physical activity confidence (1.04, SD 0.37; P=.007), parental support for child physical activity (5.54, SD 2.57; P=.04) and healthy eating (2.43, SD 1.16; P=.04), family habits for physical activity (3.02, SD 1.50; P=.049) and healthy eating (3.95, SD 1.84; P=.04), and parental identity for physical activity (2.82, SD 1.19; P=.02). Conclusions: The online EIP portal complemented the in-person sessions. Additional engagement with the portal was associated with greater improvements in child physical activity and parental support behaviors, habits, and identity for physical activity. UR - https://pediatrics.jmir.org/2022/3/e36770 UR - http://dx.doi.org/10.2196/36770 UR - http://www.ncbi.nlm.nih.gov/pubmed/35787514 ID - info:doi/10.2196/36770 ER - TY - JOUR AU - Chang, Ing-Chau AU - Yang, Cheng-Ying AU - Yen, Chin-En PY - 2022/7/1 TI - The Effects of a Computer Game (Healthy Rat King) on Preschool Children?s Nutritional Knowledge and Junk Food Intake Behavior: Nonrandomized Controlled Trial JO - JMIR Serious Games SP - e33137 VL - 10 IS - 3 KW - computer games KW - nutrition knowledge KW - junk food N2 - Background: Playing computer-aided games could enhance children?s interest in learning about nutritional knowledge and eventually promote healthy dietary intake behavior. Objective: This study aims to evaluate the effectiveness of a computer game (Healthy Rat King) in improving the knowledge on nutrition and junk food intake among preschool children in Taiwan. Methods: This was a quasi-experimental study that utilized the computer game Healthy Rat King as the nutrition education tool. We recruited 104 preschool children (aged 5-6 years) from preschools in central Taiwan, who were assigned to either the experimental group (n=56) or the control group (n=48). In the experimental group, a 1-hour computer-based educational game intervention was included in the course for 4 consecutive weeks. The control group did not receive this intervention. Results: The level of nutritional knowledge for children in the experimental group was significantly higher than those in the control group after 4 weeks (P=.002). Furthermore, the frequency of consumption of chocolate, candies, and ice cream (high-calorie junk food) was reduced in the experimental group. There was also no significant difference in the consumption of candy and chocolate (P=.54), ice cream and ice pops (P=.21), cake (P=.92), biscuit (P=.98), soft drinks (P=.52), and fruit juice and sugary drinks (P=.31) between the 2 groups in the posttest. Conclusions: Teaching using a computer game could improve children?s nutritional knowledge. However, the intake frequency of junk food among children in the experimental group showed no significant difference from those in the control group. UR - https://games.jmir.org/2022/3/e33137 UR - http://dx.doi.org/10.2196/33137 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776502 ID - info:doi/10.2196/33137 ER - TY - JOUR AU - Funk, Luke AU - Liu, Natalie PY - 2022/6/29 TI - Authors? Reply to: To Screen or Not to Screen? At Which BMI Cut Point? Comment on ?Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study? JO - J Med Internet Res SP - e39717 VL - 24 IS - 6 KW - obesity KW - body mass index KW - BMI KW - risk factors KW - screening KW - health services KW - chronic disease KW - heart disease KW - myocardial perfusion imaging KW - anxiety KW - depression UR - https://www.jmir.org/2022/6/e39717 UR - http://dx.doi.org/10.2196/39717 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767330 ID - info:doi/10.2196/39717 ER - TY - JOUR AU - Sioka, Chrissa PY - 2022/6/29 TI - To Screen or Not to Screen? At Which BMI Cut Point? Comment on ?Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study? JO - J Med Internet Res SP - e37267 VL - 24 IS - 6 KW - obesity KW - body mass index KW - BMI KW - risk factors KW - screening KW - health services KW - chronic disease KW - heart disease KW - myocardial perfusion imaging KW - anxiety KW - depression UR - https://www.jmir.org/2022/6/e37267 UR - http://dx.doi.org/10.2196/37267 UR - http://www.ncbi.nlm.nih.gov/pubmed/35767333 ID - info:doi/10.2196/37267 ER - TY - JOUR AU - Abrahams, Mariette AU - O?Grady, Rochez AU - Prawitt, Janne PY - 2022/5/31 TI - Effect of a Daily Collagen Peptide Supplement on Digestive Symptoms in Healthy Women: 2-Phase Mixed Methods Study JO - JMIR Form Res SP - e36339 VL - 6 IS - 5 KW - collagen peptides KW - collagen hydrolysates KW - digital study KW - gut KW - digestive symptoms KW - technology KW - bloating KW - Peptan KW - microbiome KW - health care professionals KW - mobile phone N2 - Background: The effect of dietary collagen on managing digestive symptoms is currently lacking in the literature. Objective: To gain a better understanding of this issue, we conducted a 2-phase mixed methods study. Methods: Phase 1 was a mixed methods design to explore current attitude and practice among consumers and health care practitioners. The findings were used to design an 8-week phase 2 digital study called Gutme! conducted in the United States in healthy female volunteers (BMI>25 kg/m2). Our aim was, first, to determine the feasibility of conducting a fully digital mixed methods study; second, the study explored the effect of an 8-week daily supplementation of 20 g dietary collagen peptide (Peptan) on digestive symptoms. Phase 2 was a prospective, open-label, longitudinal, single-arm study. Participation involved 2 weeks of baseline tracking (digestive symptoms, mood, stool, and lifestyle) using an app, followed by 8 weeks of tracking and taking 20 g collagen peptide supplement split into 2 dosages per day. Participants were required to complete a web-based symptom questionnaire at baseline, week 2, and week 8, as well as participate in 2 scheduled video interviews. Results: Phase 1 revealed that consumer awareness of collagen for digestive health is low (64/204, 31.4%). Among the dietitians prescribing collagen for their patients, the most common dosage was 20 g a day with notable effects after 6 weeks of intake. Within the phase 2 study, of the 40 recruited participants, 14 (35%) completed the full course of supplementation. The findings indicate that 93% (13/14) of those who completed the study experienced a reduction in digestive symptoms, which included bloating. Conclusions: A mixed methods digital study design is feasible and acceptable for collecting relevant data in a real-life setting. The use of a 20 g daily collagen peptide supplement may reduce bloating and improve mild digestive symptoms in otherwise healthy female adults in the absence of any other dietary or lifestyle interventions. Trial Registration: ClinicalTrials.gov NCT04245254; https://clinicaltrials.gov/ct2/show/NCT04245254 UR - https://formative.jmir.org/2022/5/e36339 UR - http://dx.doi.org/10.2196/36339 UR - http://www.ncbi.nlm.nih.gov/pubmed/35639457 ID - info:doi/10.2196/36339 ER - TY - JOUR AU - Comeras-Chueca, Cristina AU - Villalba-Heredia, Lorena AU - Perez-Lasierra, Luis Jose AU - Lozano-Berges, Gabriel AU - Matute-Llorente, Angel AU - Vicente-Rodriguez, German AU - Casajus, Antonio Jose AU - Gonzalez-Aguero, Alex PY - 2022/5/24 TI - Effect of an Active Video Game Intervention Combined With Multicomponent Exercise for Cardiorespiratory Fitness in Children With Overweight and Obesity: Randomized Controlled Trial JO - JMIR Serious Games SP - e33782 VL - 10 IS - 2 KW - active videogames KW - VO2peak KW - obesity KW - prepuberty KW - cardiorespiratory KW - fitness KW - gaming KW - childhood KW - intervention N2 - Background: Childhood overweight and obesity have become major global health problems and are negatively related with the cardiorespiratory fitness (CRF) level in school children and adolescents. Exercise, specifically multicomponent training, is effective for CRF improvement, but the main challenge is to ensure adherence to exercise in children with overweight and obesity. Therefore, new ways of exercising that are more attractive and motivational for this population are needed and playing or training with active video games (AVGs) has been proposed as an effective alternative because they require full-body movement and therefore increase energy expenditure. Objective: The main aim of this study was to investigate the effects of an AVG intervention combined with multicomponent training on CRF at maximal and submaximal intensities in children with overweight or obesity. Methods: We recruited 28 children (13 girls and 15 boys) aged 9 to 11 years with overweight or obesity from medical centers and divided them into 2 groups, an intervention group (n=20) that participated in a 5-month supervised AVG exercise program combined with multicomponent exercise, and a control group (n=8) that continued daily activities without modification. A maximal stress test to measure CRF using a walking-graded protocol with respiratory gas exchange was performed by the participants. Results: The AVG group showed a significant decrease in heart rate and oxygen uptake for the same intensities in the submaximal stages of the maximal treadmill test, as well as a lower oxygen uptake percentage according to the individual maximal oxygen uptake, whereas the control group did not show overall changes. No change in the peak oxygen uptake (VO2peak) was found. Conclusions: A 5-month AVG intervention combined with multicomponent exercise had positive effects on CRF at submaximal intensity, showing a lower heart rate and oxygen uptake at the same intensities and displaying a lower oxygen uptake percentage according to the individual (VO2peak). Greater benefits were found in children with the highest fat percentage. Trial Registration: ClinicalTrials.gov NCT04418713; https://clinicaltrials.gov/show/NCT04418713 UR - https://games.jmir.org/2022/2/e33782 UR - http://dx.doi.org/10.2196/33782 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471240 ID - info:doi/10.2196/33782 ER - TY - JOUR AU - Chardon, Matthias AU - Barbieri, Augusto Fabio AU - Penedo, Tiago AU - Santos, Rocha Paulo Cezar AU - Vuillerme, Nicolas PY - 2022/5/20 TI - The Effects of Overweight and Obesity on Obstacle Crossing During Walking: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e36234 VL - 11 IS - 5 KW - obesity KW - obstacle crossing KW - gait KW - systematic review KW - overweight KW - weight KW - obstacle KW - walking KW - balance KW - fall KW - risk KW - prevention KW - mobility N2 - Background: Overweight and obesity are significant global health concerns that involve deficits in gait and balance that affect daily activities. Although much is reported about the effect of overweight and obesity on gait during unobstructed walking, not much is known about how overweight and obesity could impact gait under more challenging conditions, such as environments with obstacles. Objective: The aim of this study is to systematically review and synthesize the available data regarding the effects of overweight and obesity on obstacle crossing during walking. Methods: This review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. PubMed, Web of Science, Scopus, and SPORTDiscus will be systematically searched with no limitations on publication date. Only full-text English-language articles published in a peer-reviewed journal will be included. Included articles must have compared obstacle crossing during walking in individuals with overweight or obesity to individuals of normal body weight. A total of 2 independent reviewers will select the articles and extract the following 4 sets of data: (1) study characteristics, (2) sample description, (3) obstacle crossing task protocol, and (4) main results obtained. If a considerable number of homogeneous papers are included, a meta-analysis will be conducted. A preliminary search was conducted in November 2021. Results: The results will include the article selection flowchart as well as tables and figures synthesizing the extracted data on the effects of overweight and obesity on obstacle crossing during walking. The preliminary search identified 73 original records, of which 5 articles met the inclusion criteria. Conclusions: This review will present researchers and clinicians with an overview of published studies that have compared the performance of obstacle crossing for individuals with overweight and obesity to those of normal body weight. Gaining insight into the control strategies adopted by individuals with overweight and obesity is critical for safe and successful obstacle crossing in this population. We therefore believe that our findings could be useful for identifying people at risk of falls and developing and implementing fall prevention programs for individuals with overweight and obesity. Trial Registration: PROSPERO CRD42021269949; https://tinyurl.com/3yrwccu4 International Registered Report Identifier (IRRID): DERR1-10.2196/36234 UR - https://www.researchprotocols.org/2022/5/e36234 UR - http://dx.doi.org/10.2196/36234 UR - http://www.ncbi.nlm.nih.gov/pubmed/35594080 ID - info:doi/10.2196/36234 ER - TY - JOUR AU - Espinosa-Curiel, Edrein Ismael AU - Pozas-Bogarin, Efrén Edgar AU - Hernández-Arvizu, Maryleidi AU - Navarro-Jiménez, Elena Maria AU - Delgado-Pérez, Emeth Edwin AU - Martínez-Miranda, Juan AU - Pérez-Espinosa, Humberto PY - 2022/5/6 TI - HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study JO - JMIR Serious Games SP - e33412 VL - 10 IS - 2 KW - serious game KW - children KW - education and behavior change KW - healthy lifestyle behaviors KW - physical activity KW - healthy eating KW - socioemotional wellness N2 - Background: The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children. Objective: We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness. Methods: Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction. Results: Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group. Conclusions: HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend. UR - https://games.jmir.org/2022/2/e33412 UR - http://dx.doi.org/10.2196/33412 UR - http://www.ncbi.nlm.nih.gov/pubmed/35522474 ID - info:doi/10.2196/33412 ER - TY - JOUR AU - Grimes, Amanda AU - Lightner, S. Joseph AU - Eighmy, Katlyn AU - Wray, D. Bridget AU - Valleroy, Ella AU - Baughn, Maya PY - 2022/5/4 TI - Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study JO - JMIR Res Protoc SP - e37126 VL - 11 IS - 5 KW - intervention protocol KW - physical activity KW - food intake KW - nutrition KW - healthy eating KW - middle schoolers KW - youth KW - school KW - student KW - fitness KW - exercise KW - food consumption KW - diet KW - fruit consumption KW - vegetable consumption N2 - Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 UR - https://www.researchprotocols.org/2022/5/e37126 UR - http://dx.doi.org/10.2196/37126 UR - http://www.ncbi.nlm.nih.gov/pubmed/35507392 ID - info:doi/10.2196/37126 ER - TY - JOUR AU - Zenun Franco, Rodrigo AU - Fallaize, Rosalind AU - Weech, Michelle AU - Hwang, Faustina AU - Lovegrove, A. Julie PY - 2022/4/25 TI - Effectiveness of Web-Based Personalized Nutrition Advice for Adults Using the eNutri Web App: Evidence From the EatWellUK Randomized Controlled Trial JO - J Med Internet Res SP - e29088 VL - 24 IS - 4 KW - personalized nutrition KW - web-based KW - nutrition app KW - app KW - dietary intervention KW - eNutri KW - precision nutrition KW - mHealth KW - healthy eating index KW - diet quality scores KW - FFQ KW - food frequency questionnaire KW - EatWellUK N2 - Background: Evidence suggests that eating behaviors and adherence to dietary guidelines can be improved using nutrition-related apps. Apps delivering personalized nutrition (PN) advice to users can provide individual support at scale with relatively low cost. Objective: This study aims to investigate the effectiveness of a mobile web app (eNutri) that delivers automated PN advice for improving diet quality, relative to general population food-based dietary guidelines. Methods: Nondiseased UK adults (aged >18 years) were randomized to PN advice or control advice (population-based healthy eating guidelines) in a 12-week controlled, parallel, single-blinded dietary intervention, which was delivered on the web. Dietary intake was assessed using the eNutri Food Frequency Questionnaire (FFQ). An 11-item US modified Alternative Healthy Eating Index (m-AHEI), which aligned with UK dietary and nutritional recommendations, was used to derive the automated PN advice. The primary outcome was a change in diet quality (m-AHEI) at 12 weeks. Participant surveys evaluated the PN report (week 12) and longer-term impact of the PN advice (mean 5.9, SD 0.65 months, after completion of the study). Results: Following the baseline FFQ, 210 participants completed at least 1 additional FFQ, and 23 outliers were excluded for unfeasible dietary intakes. The mean interval between FFQs was 10.8 weeks. A total of 96 participants were included in the PN group (mean age 43.5, SD 15.9 years; mean BMI 24.8, SD 4.4 kg/m2) and 91 in the control group (mean age 42.8, SD 14.0 years; mean BMI 24.2, SD 4.4 kg/m2). Compared with that in the control group, the overall m-AHEI score increased by 3.5 out of 100 (95% CI 1.19-5.78) in the PN group, which was equivalent to an increase of 6.1% (P=.003). Specifically, the m-AHEI components nuts and legumes and red and processed meat showed significant improvements in the PN group (P=.04). At follow-up, 64% (27/42) of PN participants agreed that, compared with baseline, they were still following some (any) of the advice received and 31% (13/42) were still motivated to improve their diet. Conclusions: These findings suggest that the eNutri app is an effective web-based tool for the automated delivery of PN advice. Furthermore, eNutri was demonstrated to improve short-term diet quality and increase engagement in healthy eating behaviors in UK adults, as compared with population-based healthy eating guidelines. This work represents an important landmark in the field of automatically delivered web-based personalized dietary interventions. Trial Registration: ClinicalTrials.gov NCT03250858; https://clinicaltrials.gov/ct2/show/NCT03250858 UR - https://www.jmir.org/2022/4/e29088 UR - http://dx.doi.org/10.2196/29088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468093 ID - info:doi/10.2196/29088 ER - TY - JOUR AU - Yau, W. Kiana AU - Tang, S. Tricia AU - Görges, Matthias AU - Pinkney, Susan AU - Kim, D. Annie AU - Kalia, Angela AU - Amed, Shazhan PY - 2022/3/28 TI - Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review JO - JMIR Pediatr Parent SP - e34967 VL - 5 IS - 1 KW - childhood obesity KW - mobile health KW - health behaviors KW - prevention KW - study design KW - systematic review KW - mobile phone N2 - Background: Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. Objective: This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. Methods: MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. Results: Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ?1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. Conclusions: Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed. UR - https://pediatrics.jmir.org/2022/1/e34967 UR - http://dx.doi.org/10.2196/34967 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343908 ID - info:doi/10.2196/34967 ER - TY - JOUR AU - Cummings, Caroline AU - Crochiere, Rebecca AU - Lansing, Hughes Amy AU - Patel, Riya AU - Stanger, Catherine PY - 2022/3/28 TI - A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial JO - JMIR Pediatr Parent SP - e32420 VL - 5 IS - 1 KW - mHealth program KW - physical activity KW - adolescent overweight KW - adolescent obesity KW - incentives KW - mobile phone N2 - Background: Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. Objective: This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. Methods: A total of 28 adolescents aged 13 to 18 years with a BMI ?90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. Results: Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04). Conclusions: The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity. UR - https://pediatrics.jmir.org/2022/1/e32420 UR - http://dx.doi.org/10.2196/32420 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343903 ID - info:doi/10.2196/32420 ER - TY - JOUR AU - Lahtio, Heli AU - Rintala, Aki AU - Immonen, Jaakko AU - Sjögren, Tuulikki PY - 2022/3/24 TI - The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis JO - J Med Internet Res SP - e25906 VL - 24 IS - 3 KW - technology KW - weight loss KW - rehabilitation KW - overweight KW - obesity KW - body mass index KW - waist circumference KW - body fat percentage KW - mobile phone N2 - Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 UR - https://www.jmir.org/2022/3/e25906 UR - http://dx.doi.org/10.2196/25906 UR - http://www.ncbi.nlm.nih.gov/pubmed/35323126 ID - info:doi/10.2196/25906 ER - TY - JOUR AU - Pearson, Nicole AU - Finch, Meghan AU - Sutherland, Rachel AU - Kingsland, Melanie AU - Wolfenden, Luke AU - Wedesweiler, Taya AU - Herrmann, Vanessa AU - Yoong, Lin Sze PY - 2022/3/17 TI - An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children?s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e27760 VL - 24 IS - 3 KW - nutrition KW - mHealth KW - child KW - preschool KW - parents N2 - Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children?s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children?s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children?s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children?s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI ?163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (?1.98 kJ, 95% CI ?343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children?s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 UR - https://www.jmir.org/2022/3/e27760 UR - http://dx.doi.org/10.2196/27760 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297768 ID - info:doi/10.2196/27760 ER - TY - JOUR AU - Li, Chuqin AU - Ademiluyi, Adesoji AU - Ge, Yaorong AU - Park, Albert PY - 2022/3/7 TI - Using Social Media to Understand Web-Based Social Factors Concerning Obesity: Systematic Review JO - JMIR Public Health Surveill SP - e25552 VL - 8 IS - 3 KW - obesity KW - web-based social factors KW - systematic review KW - social-ecological model N2 - Background: Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity. Objective: This study aims to examine web-based social factors in relation to obesity research. Methods: We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed. Results: In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users? connection to the real world. Conclusions: We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user?s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle. UR - https://publichealth.jmir.org/2022/3/e25552 UR - http://dx.doi.org/10.2196/25552 UR - http://www.ncbi.nlm.nih.gov/pubmed/35254279 ID - info:doi/10.2196/25552 ER - TY - JOUR AU - Tian, Simiao AU - Bi, Mei AU - Bi, Yanhong AU - Che, Xiaoyu AU - Liu, Yazhuo PY - 2022/3/2 TI - A Bayesian Network Analysis of the Probabilistic Relationships Between Various Obesity Phenotypes and Cardiovascular Disease Risk in Chinese Adults: Chinese Population-Based Observational Study JO - JMIR Med Inform SP - e33026 VL - 10 IS - 3 KW - Bayesian network KW - metabolic health KW - obesity KW - cardiovascular disease risk N2 - Background: Cardiovascular disease (CVD) risk among individuals with different BMI levels might depend on their metabolic health. The extent to which metabolic health status and BMI affect CVD risk, either directly or through a mediator, in the Chinese population remains unclear. Objective: In this study, the Bayesian network (BN) perspective is adopted to characterize the multivariable probabilistic connections between CVD risk and metabolic health and obesity status and identify potential factors that influence these relationships among Chinese adults. Methods: The study population comprised 6276 Chinese adults aged 30 to 74 years who participated in the China Health and Nutrition Survey 2009. BMI was used to categorize participants as normal weight, overweight, or obese, and metabolic health was defined by the Adult Treatment Panel-3 criteria. Participants were categorized into 6 phenotypes according to their metabolic health and BMI categorization. The 10-year risk of CVD was determined using the Framingham Risk Score. BN modeling was used to identify the network structure of the variables and compute the conditional probability of CVD risk for the different metabolic obesity phenotypes with the given structure. Results: Of 6276 participants, 64.67% (n=4059), 20.37% (n=1279), and 14.95% (n=938) had a low, moderate, and high 10-year CVD risk. An averaged BN with a stable network structure was constructed by learning 300 bootstrapped networks from the data. Using BN reasoning, the conditional probability of high CVD risk increased as age progressed. The conditional probability of high CVD risk was 0.43% (95% CI 0.2%-0.87%) for the 30 to 40 years age group, 2.25% (95% CI 1.75%-2.88%) for the 40 to 50 years age group, 16.13% (95% CI 14.86%-17.5%) for the 50 to 60 years age group, and 52.02% (95% CI 47.62%-56.38%) for those aged ?70 years. When metabolic health and BMI categories were instantiated to their different statuses, the conditional probability of high CVD risk increased from 7.01% (95% CI 6.27%-7.83%) for participants who were metabolically healthy normal weight to 10.47% (95% CI 7.63%-14.18%) for their metabolically healthy obese (MHO) counterparts and up to 21.74% and 34.48% among participants who were metabolically unhealthy normal weight and metabolically unhealthy obese (MUO), respectively. Sex was a significant modifier of the conditional probability distribution of metabolic obesity phenotypes and high CVD risk, with a conditional probability of high CVD risk of only 2.02% and 22.7% among MHO and MUO women, respectively, compared with 21.92% and 48.21% for their male MHO and MUO counterparts, respectively. Conclusions: BN modeling was applied to investigate the relationship between CVD risk and metabolic health and obesity phenotypes in Chinese adults. The results suggest that both metabolic health and obesity status are important for CVD prevention; closer attention should be paid to BMI and metabolic status changes over time. UR - https://medinform.jmir.org/2022/3/e33026 UR - http://dx.doi.org/10.2196/33026 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234651 ID - info:doi/10.2196/33026 ER - TY - JOUR AU - Benítez-Andrades, Alberto José AU - Alija-Pérez, José-Manuel AU - Vidal, Maria-Esther AU - Pastor-Vargas, Rafael AU - García-Ordás, Teresa María PY - 2022/2/24 TI - Traditional Machine Learning Models and Bidirectional Encoder Representations From Transformer (BERT)?Based Automatic Classification of Tweets About Eating Disorders: Algorithm Development and Validation Study JO - JMIR Med Inform SP - e34492 VL - 10 IS - 2 KW - natural language processing KW - NLP KW - social media KW - data KW - bidirectional encoder representations from transformer KW - BERT KW - deep learning KW - machine learning KW - eating disorder KW - mental health KW - model KW - classification KW - Twitter KW - nutrition KW - diet KW - weight KW - disorder KW - performance N2 - Background: Eating disorders affect an increasing number of people. Social networks provide information that can help. Objective: We aimed to find machine learning models capable of efficiently categorizing tweets about eating disorders domain. Methods: We collected tweets related to eating disorders, for 3 consecutive months. After preprocessing, a subset of 2000 tweets was labeled: (1) messages written by people suffering from eating disorders or not, (2) messages promoting suffering from eating disorders or not, (3) informative messages or not, and (4) scientific or nonscientific messages. Traditional machine learning and deep learning models were used to classify tweets. We evaluated accuracy, F1 score, and computational time for each model. Results: A total of 1,058,957 tweets related to eating disorders were collected. were obtained in the 4 categorizations, with The bidirectional encoder representations from transformer?based models had the best score among the machine learning and deep learning techniques applied to the 4 categorization tasks (F1 scores 71.1%-86.4%). Conclusions: Bidirectional encoder representations from transformer?based models have better performance, although their computational cost is significantly higher than those of traditional techniques, in classifying eating disorder?related tweets. UR - https://medinform.jmir.org/2022/2/e34492 UR - http://dx.doi.org/10.2196/34492 UR - http://www.ncbi.nlm.nih.gov/pubmed/35200156 ID - info:doi/10.2196/34492 ER - TY - JOUR AU - Kouvari, Matina AU - Karipidou, Melina AU - Tsiampalis, Thomas AU - Mamalaki, Eirini AU - Poulimeneas, Dimitrios AU - Bathrellou, Eirini AU - Panagiotakos, Demosthenes AU - Yannakoulia, Mary PY - 2022/2/14 TI - Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e30675 VL - 24 IS - 2 KW - childhood obesity KW - eHealth KW - mHealth KW - digital health KW - youth KW - mobile phone N2 - Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference ?0.61, 95% CI ?1.10 to ?0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference ?0.36, 95% CI ?0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. UR - https://www.jmir.org/2022/2/e30675 UR - http://dx.doi.org/10.2196/30675 UR - http://www.ncbi.nlm.nih.gov/pubmed/35156934 ID - info:doi/10.2196/30675 ER - TY - JOUR AU - Enyioha, Chineme AU - Hall, Matthew AU - Voisin, Christiane AU - Jonas, Daniel PY - 2022/2/4 TI - Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review JO - JMIR Public Health Surveill SP - e25890 VL - 8 IS - 2 KW - mHealth KW - mobile health KW - technology KW - diabetes KW - obesity KW - African American KW - Hispanic N2 - Background: Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective: This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods: Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results: Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions: This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes. UR - https://publichealth.jmir.org/2022/2/e25890 UR - http://dx.doi.org/10.2196/25890 UR - http://www.ncbi.nlm.nih.gov/pubmed/35119368 ID - info:doi/10.2196/25890 ER - TY - JOUR AU - Liu, Yunxin AU - Stamos, Angelos AU - Dewitte, Siegfried AU - van Berlo, C. Zeph M. AU - van der Laan, N. Laura PY - 2022/2/3 TI - Development and Evaluation of a Virtual Reality Puzzle Game to Decrease Food Intake: Randomized Controlled Trial JO - JMIR Serious Games SP - e31747 VL - 10 IS - 1 KW - virtual reality KW - pre-exposure KW - self-control KW - hedonic consumption KW - food cravings N2 - Background: Virtual reality (VR) has gained popularity in daily life, and VR food cues seem to elicit food cravings, similar to real food cues. However, little is known about the impact of VR food cues on actual food intake. Objective: In real life (RL), exposure to food cues in a situation in which the desire to eat food interferes with the completion of a food-related task reduces the subsequent food intake (ie, the pre-exposure effect). In this study, we examine, on the one hand, whether the pre-exposure effect could be replicated in RL and, on the other hand, whether this effect could be extended to VR contexts. Methods: The study used a 2 (stimulus type: food vs nonfood) × 2 (mode: VR vs RL) between-subject design (n=175). Participants were randomly assigned to 1 of the 4 conditions. Results: We found the main effect of mode on food intake, with a higher food intake after both VR conditions than after RL conditions (P=.02). In addition, among female participants, we found that exposure to both food cues (ie, VR and RL) resulted in lower food intake than exposure to both nonfood cues (P=.05). In contrast, this effect was not observed among male participants (P=.34). Additionally, VR and RL cues generated similar emotional and behavioral responses (eg, arousal and game difficulty). Conclusions: We were unable to replicate the exposure effect in our complete sample. Subgroup analyses, however, showed that for women, exposure to food cues (either in VR or in RL) reduces food intake, indicating that a VR pre-exposure procedure may effectively be applied exclusively for women. Trial Registration: ClinicalTrials.gov NCT05169996; https://clinicaltrials.gov/ct2/show/NCT05169996 UR - https://games.jmir.org/2022/1/e31747 UR - http://dx.doi.org/10.2196/31747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113028 ID - info:doi/10.2196/31747 ER - TY - JOUR AU - Gorny, Wilhelm Alexander AU - Chee, Douglas Wei Chian AU - Müller-Riemenschneider, Falk PY - 2022/1/25 TI - Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study JO - JMIR Form Res SP - e33798 VL - 6 IS - 1 KW - mHealth KW - physical activity KW - health promoting financial incentives KW - weight loss maintenance KW - young men N2 - Background: The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings. Objective: To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program. Methods: A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior. Results: Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors. Conclusions: Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change. UR - https://formative.jmir.org/2022/1/e33798 UR - http://dx.doi.org/10.2196/33798 UR - http://www.ncbi.nlm.nih.gov/pubmed/35076399 ID - info:doi/10.2196/33798 ER - TY - JOUR AU - Favaretti, Caterina AU - Vandormael, Alain AU - Hachaturyan, Violetta AU - Greuel, Merlin AU - Gates, Jennifer AU - Bärnighausen, Till AU - Adam, Maya PY - 2022/1/24 TI - Participant Engagement and Reactance to a Short, Animated Video About Added Sugars: Web-based Randomized Controlled Trial JO - JMIR Public Health Surveill SP - e29669 VL - 8 IS - 1 KW - added sugar KW - prevention KW - sugar consumption KW - short and animated story-based video KW - informational video KW - randomized controlled trial KW - social media KW - participant engagement KW - health promotion KW - United Kingdom KW - entertainment KW - patient education KW - healthy eating KW - preventive health KW - health messaging N2 - Background: Short, animated story-based (SAS) videos are a novel and promising strategy for promoting health behaviors. To gain traction as an effective health communication tool, SAS videos must demonstrate their potential to engage a diverse and global audience. In this study, we evaluate engagement with a SAS video about the consumption of added sugars, which is narrated by a child (a nonthreatening character), a mother (a neutral layperson), or a physician (a medical expert). Objective: This study aims to (1) assess whether engagement with the sugar intervention video differs by narrator type (child, mother, physician) and trait proneness to reactance and (2) assess whether the demographic characteristics of the participants (age, gender, education status) are associated with different engagement profiles with the sugar intervention video. Methods: In December 2020, after 4013 participants from the United Kingdom completed our randomized controlled trial, we offered participants assigned to the placebo arms (n=1591, 39.65%) the choice to watch the sugar intervention video (without additional compensation) as posttrial access to treatment. We measured engagement as the time that participants chose to watch the 3.42-minute video and collected data on age, gender, education status, and trait reactance proneness. Using ordinary least squares regression, we quantified the association of the demographic characteristics and trait reactance proneness with the sugar video view time. Results: Overall, 66.43% (n=1047) of the 1576 participants in the 2 placebo arms voluntarily watched the sugar intervention video. The mean view time was 116.35 (52.4%) of 222 seconds. Results show that view times did not differ by narrator (child, mother, physician) and that older participants (aged 25-59 years, mean = 125.2 seconds) watched the sugar video longer than younger adults (aged 18-25 years, mean = 83.4 seconds). View time remained consistent across education levels. Participants with low trait reactance (mean = 119.3 seconds) watched the intervention video longer than high-trait-reactance participants (mean = 95.3 seconds), although this association did not differ by narrator type. Conclusions: The majority of participants in our study voluntarily watched more than half of the sugar intervention video, which is a promising finding. Our results suggest that SAS videos may need to be shorter than 2 minutes to engage people who are young or have high trait proneness to reactance. We also found that the choice of narrator (child, mother, or physician) for our video did not significantly affect participant engagement. Future videos, aimed at reaching diverse audiences, could be customized for different age groups, where appropriate. Trial Registration: German Clinical Trials Register DRKS00022340; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340 International Registered Report Identifier (IRRID): RR2-10.2196/25343 UR - https://publichealth.jmir.org/2022/1/e29669 UR - http://dx.doi.org/10.2196/29669 UR - http://www.ncbi.nlm.nih.gov/pubmed/35072639 ID - info:doi/10.2196/29669 ER - TY - JOUR AU - Grimes, Amanda AU - Lightner, S. Joseph AU - Pina, Kimberly AU - Donis de Miranda, S. Evelyn AU - Meissen-Sebelius, Emily AU - Shook, P. Robin AU - Hurley, A. Emily PY - 2022/1/21 TI - Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19?Related Health Challenges: Formative Research Study JO - JMIR Form Res SP - e33322 VL - 6 IS - 1 KW - intervention KW - physical activity KW - nutrition KW - adolescents KW - formative research KW - COVID-19 KW - exercise KW - young adult KW - teenager KW - focus group KW - qualitative KW - interview KW - urban KW - barrier N2 - Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. UR - https://formative.jmir.org/2022/1/e33322 UR - http://dx.doi.org/10.2196/33322 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932499 ID - info:doi/10.2196/33322 ER - TY - JOUR AU - Myers-Ingram, Richard AU - Sampford, Jade AU - Milton-Cole, Rhian AU - Jones, David Gareth PY - 2022/1/20 TI - Outcomes Following eHealth Weight Management Interventions in Adults With Overweight and Obesity From Low Socioeconomic Groups: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e34546 VL - 11 IS - 1 KW - obesity KW - eHealth KW - technology KW - weight management KW - weight loss KW - low socioeconomic status KW - socioeconomic KW - systematic review KW - weight KW - obese N2 - Background: Obesity is a complex health condition with multiple associated comorbidities and increased economic costs. People from low socioeconomic status (SES) backgrounds are more likely to be overweight and obese and are less successful in traditional weight management programs. It is possible that eHealth interventions may be more successful in reaching people from low SES groups than traditional face-to-face models, by overcoming certain barriers associated with traditional interventions. It is not yet known, however, if eHealth weight management interventions are effective in people living with overweight and obesity from a low SES background. Objective: The primary aim of this study is to evaluate the efficacy of eHealth weight management interventions for people with overweight and obesity from low SES groups. Methods: A systematic review on relevant electronic databases (MEDLINE, Embase, Emcare, and CINAHL) will be undertaken to identify eligible studies published in English up until May 2021. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement to guide the systematic review, two reviewers will independently screen, select, and extract data and complete a risk of bias assessment of search results according to predefined criteria. Studies that have investigated an eHealth weight management intervention within a low SES population will be included. Primary outcomes include weight, BMI, and percentage weight change compared at baseline and at least one other time point. Secondary outcomes may include a range of anthropometric and physical fitness and activity measures. If sufficient studies are homogeneous, then we will pool results of individual outcomes using meta-analysis. Results: Searches have been completed, resulting in 2256 studies identified. Once duplicates were removed, 1545 studies remained for title and abstract review. Conclusions: The use of eHealth in weight management programs has increased significantly in recent years and will continue to do so; however, it is uncertain if eHealth weight management programs are effective in a low SES population. The results of this systematic review will therefore provide a summary of the evidence for interventions using eHealth for people living with overweight and obesity and from a low SES background. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021243973; https://tinyurl.com/2p8fxtnw International Registered Report Identifier (IRRID): DERR1-10.2196/34546 UR - https://www.researchprotocols.org/2022/1/e34546 UR - http://dx.doi.org/10.2196/34546 UR - http://www.ncbi.nlm.nih.gov/pubmed/35049506 ID - info:doi/10.2196/34546 ER - TY - JOUR AU - Richards, Rebecca AU - Jones, A. Rebecca AU - Whittle, Fiona AU - Hughes, A. Carly AU - Hill, J. Andrew AU - Lawlor, R. Emma AU - Bostock, Jennifer AU - Bates, Sarah AU - Breeze, R. Penny AU - Brennan, Alan AU - Thomas, V. Chloe AU - Stubbings, Marie AU - Woolston, Jennifer AU - Griffin, J. Simon AU - Ahern, L. Amy PY - 2022/1/7 TI - Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy?Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach JO - JMIR Form Res SP - e31801 VL - 6 IS - 1 KW - weight management KW - eHealth KW - acceptance and commitment therapy KW - third-wave cognitive behavioral therapy KW - guided self-help N2 - Background: The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective: The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results: This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions: This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial. UR - https://formative.jmir.org/2022/1/e31801 UR - http://dx.doi.org/10.2196/31801 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994698 ID - info:doi/10.2196/31801 ER - TY - JOUR AU - Vepsäläinen, Henna AU - Skaffari, Essi AU - Wojtkowska, Katarzyna AU - Barli?ska, Julia AU - Kinnunen, Satu AU - Makkonen, Riikka AU - Heikkilä, Maria AU - Lehtovirta, Mikko AU - Ray, Carola AU - Suhonen, Eira AU - Nevalainen, Jaakko AU - Sajaniemi, Nina AU - Erkkola, Maijaliisa PY - 2022/1/4 TI - A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial JO - JMIR Mhealth Uhealth SP - e30352 VL - 10 IS - 1 KW - gamification KW - intervention KW - behavior change KW - health game KW - games for health KW - smartphone app KW - mobile phone N2 - Background: Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce. Objective: This paper describes the development of the Mole?s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years. Methods: A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children?s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children?s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up. Results: A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52). Conclusions: The Mole?s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments. Trial Registration: ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283 UR - https://mhealth.jmir.org/2022/1/e30352 UR - http://dx.doi.org/10.2196/30352 UR - http://www.ncbi.nlm.nih.gov/pubmed/34982718 ID - info:doi/10.2196/30352 ER - TY - JOUR AU - Krukowski, Rebecca AU - Johnson, Brandi AU - Kim, Hyeonju AU - Sen, Saunak AU - Homsi, Riad PY - 2021/12/24 TI - A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e30578 VL - 5 IS - 12 KW - pregnancy KW - weight KW - physical activity KW - self-weighing N2 - Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine?s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks? gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive?based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive?based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 UR - https://formative.jmir.org/2021/12/e30578 UR - http://dx.doi.org/10.2196/30578 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951594 ID - info:doi/10.2196/30578 ER - TY - JOUR AU - Tzelepis, Flora AU - Mitchell, Aimee AU - Wilson, Louise AU - Byrnes, Emma AU - Haschek, Alexandra AU - Leigh, Lucy AU - Oldmeadow, Christopher PY - 2021/12/21 TI - The Long-Term Effectiveness of Internet-Based Interventions on Multiple Health Risk Behaviors: Systematic Review and Robust Variance Estimation Meta-analysis JO - J Med Internet Res SP - e23513 VL - 23 IS - 12 KW - internet KW - multiple health behaviors KW - tobacco KW - nutrition KW - alcohol KW - physical activity N2 - Background: Smoking tobacco, poor nutrition, risky alcohol use, and physical inactivity (SNAP) behaviors tend to cluster together. Health benefits may be maximized if interventions targeted multiple health risk behaviors together rather than addressing single behaviors. The internet has wide reach and is a sustainable mode for delivery of interventions for multiple health behaviors. However, no systematic reviews have examined the long-term effectiveness of internet-based interventions on any combination of or all SNAP behaviors in adults aged 18 years or older. Objective: This systematic review examined, among adults (aged ?18 years), the effectiveness of internet-based interventions on SNAP behaviors collectively in the long term compared with a control condition. Methods: The electronic databases Medline, PsycINFO, Embase, CINAHL, and Scopus were searched to retrieve studies describing the effectiveness of internet-based interventions on ?2 SNAP behaviors published by November 18, 2019. The reference lists of retrieved articles were also checked to identify eligible publications. The inclusion criteria were randomized controlled trials or cluster randomized controlled trials with adults examining an internet-based intervention measuring the effect on ?2 SNAP behaviors at least 6 months postrecruitment and published in English in a peer-reviewed journal. Two reviewers independently extracted data from included studies and assessed methodological quality using the Quality Assessment Tool for Quantitative Studies. A robust variance estimation meta-analysis was performed to examine the long-term effectiveness of internet-based interventions on all 4 SNAP risk behavior outcomes. All SNAP outcomes were coded so they were in the same direction, with higher scores equating to worse health risk behaviors. Results: The inclusion criteria were met by 11 studies: 7 studies measured the effect of an internet-based intervention on nutrition and physical activity; 1 study measured the effect on smoking, nutrition, and physical activity; and 3 studies measured the effect on all SNAP behaviors. Compared with the control group, internet-based interventions achieved an overall significant improvement across all SNAP behaviors in the long term (standardized mean difference ?0.12 [improvement as higher scores = worse health risk outcomes], 95% CI ?0.19 to ?0.05; I2=1.5%, P=.01). The global methodological quality rating was ?moderate? for 1 study, while the remaining 10 studies were rated as ?weak.? Conclusions: Internet-based interventions were found to produce an overall significant improvement across all SNAP behaviors collectively in the long term. Internet-based interventions targeting multiple SNAP behaviors have the potential to maximize long-term improvements to preventive health outcomes. UR - https://www.jmir.org/2021/12/e23513 UR - http://dx.doi.org/10.2196/23513 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931990 ID - info:doi/10.2196/23513 ER - TY - JOUR AU - Braakhuis, Andrea AU - Gillies, Nicola AU - Worthington, Anna AU - Knowles, Scott AU - Conner, Tamlin AU - Roy, Rajshri AU - Pham, Toan AU - Bermingham, Emma AU - Cameron-Smith, David PY - 2021/12/21 TI - A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30909 VL - 10 IS - 12 KW - protein KW - meat KW - vegetarian KW - eating patterns KW - diet KW - nutrition KW - dietary restrictions KW - biomarkers KW - health KW - well-being KW - macronutrients KW - micronutrients N2 - Background: The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens. Objective: The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being. Methods: A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t0), week 5 into the intervention (t5), and post intervention (t10). Results: The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health?s Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication. Conclusions: To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet. Trial Registration: ClinicalTrials.gov NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 International Registered Report Identifier (IRRID): PRR1-10.2196/30909 UR - https://www.researchprotocols.org/2021/12/e30909 UR - http://dx.doi.org/10.2196/30909 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931994 ID - info:doi/10.2196/30909 ER - TY - JOUR AU - Whitton, Clare AU - Healy, D. Janelle AU - Collins, E. Clare AU - Mullan, Barbara AU - Rollo, E. Megan AU - Dhaliwal, S. Satvinder AU - Norman, Richard AU - Boushey, J. Carol AU - Delp, J. Edward AU - Zhu, Fengqing AU - McCaffrey, A. Tracy AU - Kirkpatrick, I. Sharon AU - Atyeo, Paul AU - Mukhtar, Aqif Syed AU - Wright, L. Janine AU - Ramos-García, César AU - Pollard, M. Christina AU - Kerr, A. Deborah PY - 2021/12/16 TI - Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study JO - JMIR Res Protoc SP - e32891 VL - 10 IS - 12 KW - 24-hour recall KW - Automated Self-Administered Dietary Assessment Tool KW - Intake24 KW - mobile food record KW - image-assisted dietary assessment KW - validation KW - controlled feeding KW - accuracy KW - dietary measurement error KW - self-report KW - energy intake KW - adult KW - cost-effectiveness KW - acceptability KW - mobile technology KW - diet surveys KW - mobile phone N2 - Background: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. Objective: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. Methods: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. Results: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. Conclusions: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s International Registered Report Identifier (IRRID): DERR1-10.2196/32891 UR - https://www.researchprotocols.org/2021/12/e32891 UR - http://dx.doi.org/10.2196/32891 UR - http://www.ncbi.nlm.nih.gov/pubmed/34924357 ID - info:doi/10.2196/32891 ER - TY - JOUR AU - Kay, C. Melissa AU - Hammad, M. Nour AU - Herring, J. Sharon AU - Bennett, G. Gary PY - 2021/12/15 TI - Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study JO - JMIR Res Protoc SP - e32441 VL - 10 IS - 12 KW - WIC KW - diet quality KW - digital health KW - text messaging KW - mothers KW - postpartum KW - child obesity KW - mobile phone N2 - Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ?2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants? diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 UR - https://www.researchprotocols.org/2021/12/e32441 UR - http://dx.doi.org/10.2196/32441 UR - http://www.ncbi.nlm.nih.gov/pubmed/34914616 ID - info:doi/10.2196/32441 ER - TY - JOUR AU - Batta, Nisha AU - Shangraw, Sarah AU - Nicklawsky, Andrew AU - Yamauchi, Takeshi AU - Zhai, Zili AU - Ravindran Menon, Dinoop AU - Gao, Dexiang AU - Dellavalle, P. Robert AU - Fujita, Mayumi PY - 2021/12/13 TI - Global Melanoma Correlations With Obesity, Smoking, and Alcohol Consumption JO - JMIR Dermatol SP - e31275 VL - 4 IS - 2 KW - melanoma incidence KW - melanoma mortality KW - non-UV risk factors KW - obesity KW - alcohol consumption KW - smoking KW - wine KW - World Health Organization KW - WHO KW - Global Cancer Observatory KW - GCO KW - Global Health Observatory KW - GHO KW - aldehyde dehydrogenase 2 KW - ALDH2 KW - polymorphism UR - https://derma.jmir.org/2021/2/e31275 UR - http://dx.doi.org/10.2196/31275 UR - http://www.ncbi.nlm.nih.gov/pubmed/35990801 ID - info:doi/10.2196/31275 ER - TY - JOUR AU - Bughin, François AU - Bui, Gaspard AU - Ayoub, Bronia AU - Blervaque, Leo AU - Saey, Didier AU - Avignon, Antoine AU - Brun, Frédéric Jean AU - Molinari, Nicolas AU - Pomies, Pascal AU - Mercier, Jacques AU - Gouzi, Fares AU - Hayot, Maurice PY - 2021/12/6 TI - Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e28242 VL - 9 IS - 12 KW - telerehabilitation KW - mHealth KW - rehabilitation KW - obesity KW - mobile phone N2 - Background: Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective: The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods: This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients? adhesion, and satisfaction. Results: A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: ?0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: ?1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions: In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients? adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration: ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666 UR - https://mhealth.jmir.org/2021/12/e28242 UR - http://dx.doi.org/10.2196/28242 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874887 ID - info:doi/10.2196/28242 ER - TY - JOUR AU - Goldstein, P. Stephanie AU - Zhang, Fengqing AU - Klasnja, Predrag AU - Hoover, Adam AU - Wing, R. Rena AU - Thomas, Graham John PY - 2021/12/6 TI - Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial JO - JMIR Res Protoc SP - e33568 VL - 10 IS - 12 KW - obesity KW - weight loss KW - dietary adherence KW - just-in-time adaptive intervention KW - microrandomized trial KW - mobile phone N2 - Background: Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. Objective: The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. Methods: Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. Results: The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. Conclusions: This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). Trial Registration: ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585 International Registered Report Identifier (IRRID): DERR1-10.2196/33568 UR - https://www.researchprotocols.org/2021/12/e33568 UR - http://dx.doi.org/10.2196/33568 UR - http://www.ncbi.nlm.nih.gov/pubmed/34874892 ID - info:doi/10.2196/33568 ER - TY - JOUR AU - Harrington, Katharine AU - Zenk, N. Shannon AU - Van Horn, Linda AU - Giurini, Lauren AU - Mahakala, Nithya AU - Kershaw, N. Kiarri PY - 2021/12/2 TI - The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study JO - JMIR Form Res SP - e27512 VL - 5 IS - 12 KW - ecological momentary assessment KW - eating behaviors KW - crowdsourcing KW - food consumption images KW - food image processing KW - mobile phone N2 - Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility?usability and acceptability?of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. UR - https://formative.jmir.org/2021/12/e27512 UR - http://dx.doi.org/10.2196/27512 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860666 ID - info:doi/10.2196/27512 ER - TY - JOUR AU - Laforest, Marie-Eve AU - Ward, Stephanie AU - Landry, Liette-Andrée AU - Mobetty, Fabrice PY - 2021/12/2 TI - The Relationship Between Paternal Preconception Obesity and Health Behaviors and Childhood Obesity: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e31254 VL - 10 IS - 12 KW - childhood obesity KW - preconception KW - paternal obesity KW - health behaviours KW - obesity KW - public health KW - children KW - adolescents KW - body weight KW - parenting KW - health behaviors N2 - Background: Childhood obesity is a global public health concern and is a priority for researchers and policy makers. To overcome the epidemic of obesity, influencing factors throughout the life span need to be addressed, including those in the preconception period. A better understanding of the association between paternal preconception factors and childhood obesity is important for public health interventions. Objective: This systematic review will examine the relationship between paternal preconception obesity and health behaviors and their offspring?s overweight or obesity. Methods: Peer-reviewed quantitative studies and grey literature that report associations between paternal preconception obesity and health behaviors?such as smoking, exercise, and eating habits?and childhood overweight and obesity will be identified through a computerized literature search in 7 databases. The quality of each study will be assessed using the Quality Assessment Tool for Quantitative Studies. Characteristics of the included studies will be reported, and relevant findings from each paternal preconception exposure will be narratively synthesized. This review will follow the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines. Results: This systematic review is anticipated to begin in December 2021 and be completed by the end of August 2022. Conclusions: This systematic review will contribute to a better understanding of the relationship between preconception paternal exposures and their offspring?s overweight or obesity. Findings will help support health professionals working with prospective parents to educate fathers on the benefits of improving their weight and health behaviors during the preconception period. International Registered Report Identifier (IRRID): PRR1-10.2196/31254 UR - https://www.researchprotocols.org/2021/12/e31254 UR - http://dx.doi.org/10.2196/31254 UR - http://www.ncbi.nlm.nih.gov/pubmed/34860672 ID - info:doi/10.2196/31254 ER - TY - JOUR AU - Trofholz, Amanda AU - Tate, Allan AU - Janowiec, Mark AU - Fertig, Angela AU - Loth, Katie AU - de Brito, N. Junia AU - Berge, Jerica PY - 2021/12/1 TI - Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study JO - JMIR Res Protoc SP - e30525 VL - 10 IS - 12 KW - methods KW - ecological momentary assessment KW - weight-related behaviors KW - racially and ethnically diverse KW - children KW - mobile phone N2 - Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent?s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child?s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants? time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 UR - https://www.researchprotocols.org/2021/12/e30525 UR - http://dx.doi.org/10.2196/30525 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855612 ID - info:doi/10.2196/30525 ER - TY - JOUR AU - Wyse, Rebecca AU - Delaney, Tessa AU - Stacey, Fiona AU - Lecathelinais, Christophe AU - Ball, Kylie AU - Zoetemeyer, Rachel AU - Lamont, Hannah AU - Sutherland, Rachel AU - Nathan, Nicole AU - Wiggers, H. John AU - Wolfenden, Luke PY - 2021/11/29 TI - Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students? Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e31734 VL - 23 IS - 11 KW - child diet KW - consumer behavior KW - intervention KW - RCT KW - public health nutrition KW - obesity KW - school KW - school canteen KW - long-term follow-up KW - choice architecture KW - public health KW - nutrition KW - children KW - diet KW - eHealth KW - school lunch N2 - Background: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective: This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students? lunch orders 18 months after baseline. Methods: This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results: In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (?74.1 kJ; 95% CI [?124.7, ?23.4]; P=.006) and saturated fat (?0.4 g; 95% CI [?0.7, ?0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a ?2.6% change). There was no between-group difference over time in canteen revenue. Conclusions: This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075 UR - https://www.jmir.org/2021/11/e31734 UR - http://dx.doi.org/10.2196/31734 UR - http://www.ncbi.nlm.nih.gov/pubmed/34847063 ID - info:doi/10.2196/31734 ER - TY - JOUR AU - Prowse, Rachel AU - Carsley, Sarah PY - 2021/11/25 TI - Digital Interventions to Promote Healthy Eating in Children: Umbrella Review JO - JMIR Pediatr Parent SP - e30160 VL - 4 IS - 4 KW - children KW - healthy eating KW - eHealth KW - nutrition intervention KW - nutrition education KW - food literacy KW - digital health KW - virtual delivery KW - digital interventions KW - nutrition interventions KW - best practices KW - education KW - mobile phone N2 - Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. UR - https://pediatrics.jmir.org/2021/4/e30160 UR - http://dx.doi.org/10.2196/30160 UR - http://www.ncbi.nlm.nih.gov/pubmed/34842561 ID - info:doi/10.2196/30160 ER - TY - JOUR AU - Lawhun Costello, Victoria AU - Chevance, Guillaume AU - Wing, David AU - Mansour-Assi, J. Shadia AU - Sharp, Sydney AU - Golaszewski, M. Natalie AU - Young, A. Elizabeth AU - Higgins, Michael AU - Ibarra, Anahi AU - Larsen, Britta AU - Godino, G. Job PY - 2021/11/24 TI - Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis JO - JMIR Public Health Surveill SP - e28317 VL - 7 IS - 11 KW - COVID-19 KW - young adults KW - physical activity KW - sedentary behavior KW - activity monitor KW - public health KW - wearable KW - activity monitors KW - wrist worn KW - sedentary KW - lifestyle KW - pandemic N2 - Background: The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. Objective: In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. Methods: Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ?250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. Results: After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (?2872 steps per day; 95% CI ?2734 to ?3010), light physical activity times (?41.9 minutes; 95% CI ?39.5 to ?44.3), and moderate-to-vigorous physical activity times (?12.2 minutes; 95% CI ?10.6 to ?13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. Conclusions: Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic. UR - https://publichealth.jmir.org/2021/11/e28317 UR - http://dx.doi.org/10.2196/28317 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665759 ID - info:doi/10.2196/28317 ER - TY - JOUR AU - Chang, Angela AU - Schulz, Johannes Peter AU - Jiao, Wen AU - Liu, Tingchi Matthew PY - 2021/11/23 TI - Obesity-Related Communication in Digital Chinese News From Mainland China, Hong Kong, and Taiwan: Automated Content Analysis JO - JMIR Public Health Surveill SP - e26660 VL - 7 IS - 11 KW - public health KW - computational content KW - digital research methods KW - obesity discourse KW - gene disorders KW - noncommunicable disease N2 - Background: The fact that the number of individuals with obesity has increased worldwide calls into question media efforts for informing the public. This study attempts to determine the ways in which the mainstream digital news covers the etiology of obesity and diseases associated with the burden of obesity. Objective: The dual objectives of this study are to obtain an understanding of what the news reports on obesity and to explore meaning in data by extending the preconceived grounded theory. Methods: The 10 years of news text from 2010 to 2019 compared the development of obesity-related coverage and its potential impact on its perception in Mainland China, Hong Kong, and Taiwan. Digital news stories on obesity along with affliction and inferences in 9 Chinese mainstream newspapers were sampled. An automatic content analysis tool, DiVoMiner was proposed. This computer-aided platform is designed to organize and filter large sets of data on the basis of the patterns of word occurrence and term discovery. Another programming language, Python 3, was used to explore connections and patterns created by the aggregated interactions. Results: A total of 30,968 news stories were identified with increasing attention since 2016. The highest intensity of newspaper coverage of obesity communication was observed in Taiwan. Overall, a stronger focus on 2 shared causative attributes of obesity is on stress (n=4483, 33.0%) and tobacco use (n=3148, 23.2%). The burdens of obesity and cardiovascular diseases are implied to be the most, despite the aggregated interaction of edge centrality showing the highest link between the ?cancer? and obesity. This study goes beyond traditional journalism studies by extending the framework of computational and customizable web-based text analysis. This could set a norm for researchers and practitioners who work on data projects largely for an innovative attempt. Conclusions: Similar to previous studies, the discourse between the obesity epidemic and personal afflictions is the most emphasized approach. Our study also indicates that the inclination of blaming personal attributes for health afflictions potentially limits social and governmental responsibility for addressing this issue. UR - https://publichealth.jmir.org/2021/11/e26660 UR - http://dx.doi.org/10.2196/26660 UR - http://www.ncbi.nlm.nih.gov/pubmed/34817383 ID - info:doi/10.2196/26660 ER - TY - JOUR AU - Hachaturyan, Violetta AU - Adam, Maya AU - Favaretti, Caterina AU - Greuel, Merlin AU - Gates, Jennifer AU - Bärnighausen, Till AU - Vandormael, Alain PY - 2021/11/22 TI - Reactance to Social Authority in a Sugar Reduction Informational Video: Web-Based Randomized Controlled Trial of 4013 Participants JO - J Med Internet Res SP - e29664 VL - 23 IS - 11 KW - sugar reduction KW - reactance KW - animated video KW - digital intervention KW - health communication N2 - Background: Short and animated story-based (SAS) videos can be an effective strategy for promoting health messages. However, health promotion strategies often motivate the rejection of health messages, a phenomenon known as reactance. In this study, we examine whether the child narrator of a SAS video (perceived as nonthreatening, with low social authority) minimizes reactance to a health message about the consumption of added sugars. Objective: This study aims to determine whether our SAS intervention video attenuates reactance to the sugar message when compared with a content placebo video (a health message about sunscreen) and a placebo video (a nonhealth message about earthquakes) and determine if the child narrator is more effective at reducing reactance to the sugar message when compared with the mother narrator (equivalent social authority to target audience) or family physician narrator (high social authority) of the same SAS video. Methods: This is a web-based randomized controlled trial comparing an intervention video about sugar reduction narrated by a child, the child?s mother, or the family physician with a content placebo video about sunscreen use and a placebo video about earthquakes. The primary end points are differences in the antecedents to reactance (proneness to reactance, threat level of the message), its components (anger and negative cognition), and outcomes (source appraisal and attitude). We performed analysis of variance on data collected (N=4013) from participants aged 18 to 59 years who speak English and reside in the United Kingdom. Results: Between December 9 and December 11, 2020, we recruited 38.62% (1550/4013) men, 60.85% (2442/4013) women, and 0.52% (21/4013) others for our study. We found a strong causal relationship between the persuasiveness of the content promoted by the videos and the components of reactance. Compared with the placebo (mean 1.56, SD 0.63) and content placebo (mean 1.76, SD 0.69) videos, the intervention videos (mean 1.99, SD 0.83) aroused higher levels of reactance to the message content (P<.001). We found no evidence that the child narrator (mean 1.99, SD 0.87) attenuated reactance to the sugar reduction message when compared with the physician (mean 1.95, SD 0.79; P=.77) and mother (mean 2.03, SD 0.83; P=.93). In addition, the physician was perceived as more qualified, reliable, and having more expertise than the child (P<.001) and mother (P<.001) narrators. Conclusions: Although children may be perceived as nonthreatening messengers, we found no evidence that a child narrator attenuated reactance to a SAS video about sugar consumption when compared with a physician. Furthermore, our intervention videos, with well-intended goals toward audience health awareness, aroused higher levels of reactance when compared with the placebo videos. Our results highlight the challenges in developing effective interventions to promote persuasive health messages. Trial Registration: German Clinical Trials Registry DRKS00022340; https://tinyurl.com/mr8dfena International Registered Report Identifier (IRRID): RR2-10.2196/25343 UR - https://www.jmir.org/2021/11/e29664 UR - http://dx.doi.org/10.2196/29664 UR - http://www.ncbi.nlm.nih.gov/pubmed/34813490 ID - info:doi/10.2196/29664 ER - TY - JOUR AU - Pant, Ichhya AU - Rimal, Rajiv AU - Yilma, Hagere AU - Bingenheimer, Jeffrey AU - Sedlander, Erica AU - Behera, Sibabrata PY - 2021/11/22 TI - mHealth for Anemia Reduction: Protocol for an Entertainment Education?Based Dual Intervention JO - JMIR Res Protoc SP - e26252 VL - 10 IS - 11 KW - mHealth KW - interactive KW - voice response KW - entertainment KW - education KW - rural KW - anemia KW - bystander KW - violence against women N2 - Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India?s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education?based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women?related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study?s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms?based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women?related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 UR - https://www.researchprotocols.org/2021/11/e26252 UR - http://dx.doi.org/10.2196/26252 UR - http://www.ncbi.nlm.nih.gov/pubmed/34812735 ID - info:doi/10.2196/26252 ER - TY - JOUR AU - Park, Jihyun AU - Park, Mi-Jeong AU - Seo, Young-Gyun PY - 2021/11/17 TI - Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e29003 VL - 23 IS - 11 KW - ICT KW - eHealth KW - mHealth KW - weight loss KW - obesity KW - BMI KW - meta-analysis KW - randomized controlled trial KW - children KW - adolescents KW - mobile phone N2 - Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=?1.26 kg/m2, 95% CI ?2.24 to ?0.28), lifestyle modification comparator (WMD=?1.75, 95% CI ?2.76 to ?0.74), intervention involving both boys and girls (WMD=?1.30, 95% CI ?2.14 to ?0.46), and intervention involving obesity only (WMD=?1.92, 95% CI ?3.75 to ?0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. UR - https://www.jmir.org/2021/11/e29003 UR - http://dx.doi.org/10.2196/29003 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787572 ID - info:doi/10.2196/29003 ER - TY - JOUR AU - Chatterjee, Ayan AU - Prinz, Andreas AU - Gerdes, Martin AU - Martinez, Santiago PY - 2021/11/17 TI - Digital Interventions on Healthy Lifestyle Management: Systematic Review JO - J Med Internet Res SP - e26931 VL - 23 IS - 11 KW - eHealth KW - digital intervention KW - lifestyle KW - obesity KW - challenges KW - mobile phone N2 - Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. UR - https://www.jmir.org/2021/11/e26931 UR - http://dx.doi.org/10.2196/26931 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787575 ID - info:doi/10.2196/26931 ER - TY - JOUR AU - Borloz, Sylvie AU - Bucher Della Torre, Sophie AU - Collet, Tinh-Hai AU - Jotterand Chaparro, Corinne PY - 2021/11/15 TI - Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study JO - JMIR Pediatr Parent SP - e28608 VL - 4 IS - 4 KW - adolescent KW - obesity KW - ultraprocessed foods KW - qualitative food intake KW - food educational style KW - smartphone application N2 - Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent?s food educational style using the Kids? Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 UR - https://pediatrics.jmir.org/2021/4/e28608 UR - http://dx.doi.org/10.2196/28608 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779776 ID - info:doi/10.2196/28608 ER - TY - JOUR AU - Carey, Alissa AU - Yang, Qiuchen AU - DeLuca, Laura AU - Toro-Ramos, Tatiana AU - Kim, Youngin AU - Michaelides, Andreas PY - 2021/11/8 TI - The Relationship Between Weight Loss Outcomes and Engagement in a Mobile Behavioral Change Intervention: Retrospective Analysis JO - JMIR Mhealth Uhealth SP - e30622 VL - 9 IS - 11 KW - engagement KW - mHealth KW - obesity KW - weight management KW - Noom KW - application KW - app KW - behavioral change KW - digital behavior change interventions N2 - Background: There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss. Objective: This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: 10% or greater body weight loss; moderate weight loss: between 5% to 10%; stable weight: 0 plus or minus 1%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks. Methods: Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks, and 33-52 weeks. Results: At 9-16 weeks, among the 11,252 participants, 2594 (23.05%) had stable weight, 6440 (57.23%) had moderate weight loss, and 2218 (19.71%) had high weight loss. By 33-52 weeks, 525 (18.21%) had stable weight, 1214 (42.11%) had moderate weight loss, and 1144 (39.68%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than was stable weight (all P values <.001). These differences held across all time periods with the exception of exercise for the moderate weight loss category at 1 time period of 33-52 weeks. Exercise logging increased from 9 to 52 weeks regardless of the weight loss group. Conclusions: Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week both in the short-term and long-term (ie, 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed mobile DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs. UR - https://mhealth.jmir.org/2021/11/e30622 UR - http://dx.doi.org/10.2196/30622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34747706 ID - info:doi/10.2196/30622 ER - TY - JOUR AU - Alvarez-Mon, Angel Miguel AU - Llavero-Valero, Maria AU - Asunsolo del Barco, Angel AU - Zaragozá, Cristina AU - Ortega, A. Miguel AU - Lahera, Guillermo AU - Quintero, Javier AU - Alvarez-Mon, Melchor PY - 2021/10/26 TI - Areas of Interest and Attitudes Toward Antiobesity Drugs: Thematic and Quantitative Analysis Using Twitter JO - J Med Internet Res SP - e24336 VL - 23 IS - 10 KW - obesity KW - social media KW - Twitter KW - drug therapy KW - pharmacotherapy KW - attitude KW - thematic analysis KW - quantitative analysis KW - drug N2 - Background: Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research. Objective: The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs. Methods: In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured. Results: We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community. Conclusions: This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users. UR - https://www.jmir.org/2021/10/e24336 UR - http://dx.doi.org/10.2196/24336 UR - http://www.ncbi.nlm.nih.gov/pubmed/34698653 ID - info:doi/10.2196/24336 ER - TY - JOUR AU - Bragg, Marie AU - Lutfeali, Samina AU - Greene, Tenay AU - Osterman, Jessica AU - Dalton, Madeline PY - 2021/10/22 TI - How Food Marketing on Instagram Shapes Adolescents? Food Preferences: Online Randomized Trial JO - J Med Internet Res SP - e28689 VL - 23 IS - 10 KW - food marketing KW - traditional media KW - social media KW - adolescents KW - Instagram N2 - Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children?s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents? preferences. Objective: This study examined whether adolescents could identify food companies? Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents? preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame?which includes the logo, comments, and ?likes.? In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the ?labeled ad condition.? In the ?unlabeled ad condition,? however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. UR - https://www.jmir.org/2021/10/e28689 UR - http://dx.doi.org/10.2196/28689 UR - http://www.ncbi.nlm.nih.gov/pubmed/34677136 ID - info:doi/10.2196/28689 ER - TY - JOUR AU - Porter, Gwenndolyn AU - Michaud, L. Tzeyu AU - Schwab, J. Robert AU - Hill, L. Jennie AU - Estabrooks, A. Paul PY - 2021/10/20 TI - Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial JO - JMIR Form Res SP - e28622 VL - 5 IS - 10 KW - weight management KW - rural KW - RE-AIM KW - hybrid effectiveness-implementation KW - primary care KW - obesity KW - physicians KW - digital health KW - health technology KW - mobile phone N2 - Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry?derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ?25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557 UR - https://formative.jmir.org/2021/10/e28622 UR - http://dx.doi.org/10.2196/28622 UR - http://www.ncbi.nlm.nih.gov/pubmed/34668873 ID - info:doi/10.2196/28622 ER - TY - JOUR AU - Comeras-Chueca, Cristina AU - Marin-Puyalto, Jorge AU - Matute-Llorente, Angel AU - Vicente-Rodriguez, German AU - Casajus, Antonio Jose AU - Gonzalez-Aguero, Alex PY - 2021/10/18 TI - Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents With Overweight or Obesity: Systematic Review and Meta-Analysis JO - JMIR Serious Games SP - e29981 VL - 9 IS - 4 KW - active videogames KW - exergaming KW - BMI KW - body fat KW - motor skills KW - cardiorespiratory fitness KW - muscle N2 - Background: Childhood obesity is one of the most important public health problems. Active video games (AVGs) have been proposed as an attractive alternative to increase energy expenditure and are being investigated to determine their effectiveness against childhood obesity. Objective: The aim of this study is to summarize the existing research and draw conclusions about the effects of AVGs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. Methods: The search strategy was applied to PubMed, MEDLINE, Web of Science, and SPORTDiscus, including randomized and nonrandomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. To measure the risk of bias in randomized and nonrandomized controlled trials, 2 different quality assessment tools were used. In total, 15 articles met the inclusion criteria, and the variables of interest were BMI, body fat percentage, cardiorespiratory fitness (CRF), waist circumference, fat-free mass, muscular fitness, and motor competence. A meta-analysis was performed. Results: Positive effects were found for BMI and body fat percentage, favoring the AVG group compared with a control group with no intervention (mean difference ?0.209; 95% CI ?0.388 to ?0.031 vs mean difference ?0.879; 95% CI ?1.138 to ?0.602). Positive effects seem to be observed for CRF. The effects of AVG interventions on muscular fitness, fat-free mass, waist circumference, and motor competence are unclear. Conclusions: AVG programs showed positive effects on BMI, body fat percentage, and CRF. AVG could be a good strategy to combat childhood obesity. UR - https://games.jmir.org/2021/4/e29981 UR - http://dx.doi.org/10.2196/29981 UR - http://www.ncbi.nlm.nih.gov/pubmed/34661549 ID - info:doi/10.2196/29981 ER - TY - JOUR AU - Kinney, A. Gigi AU - Haddad, N. Eliot AU - Garrow, S. Linda AU - Ng, W. Perry K. AU - Comstock, S. Sarah PY - 2021/10/6 TI - An Intervention With Michigan-Grown Wheat in Healthy Adult Humans to Determine Effect on Gut Microbiota: Protocol for a Crossover Trial JO - JMIR Res Protoc SP - e29046 VL - 10 IS - 10 KW - fiber KW - microbiota KW - whole grain KW - wheat KW - butyrate KW - calprotectin KW - lipocalin-2 N2 - Background: Daily fiber intake can increase the diversity of the human gut microbiota as well as the abundance of beneficial microbes and their metabolites. Whole-grain wheat is high in fiber. Objective: This manuscript presents a study protocol designed to understand the effects of different types of wheat on gastrointestinal tract microbes. Methods: Human adults will consume crackers made from three types of wheat flour (refined soft white wheat, whole-grain soft white wheat, and whole-grain soft red wheat). In this study, participants will alternate between crackers made from refined soft white wheat flour to those made from whole-grain soft white wheat and whole-grain soft red wheat flour. Survey and stool sample collection will occur after 7-day treatment periods. We will assess how wheat consumption affects gastrointestinal bacteria by sequencing the V4 region of 16S rRNA gene amplicons and the inflammatory state of participants? intestines using enzyme-linked immunosorbent assays. The butyrate production capacity of the gut microbiota will be determined by targeted quantitative real-time polymerase chain reaction. Results: We will report the treatment effects on alpha and beta diversity of the microbiota and taxa-specific differences. Microbiota results will be analyzed using the vegan package in R. Butyrate production capacity and biomarkers of intestinal inflammation will be analyzed using parametric statistical methods such as analysis of variance or linear regression. We expect whole wheat intake to increase butyrate production capacity, bacterial alpha diversity, and abundance of bacterial taxa responsive to phenolic compounds. Soft red wheat is also expected to decrease the concentration of inflammatory biomarkers in the stool of participants. Conclusions: This protocol describes the methods to be used in a study on the impact of wheat types on the human gastrointestinal microbiota and biomarkers of intestinal inflammation. The analysis of intestinal responses to the consumption of two types of whole wheat will expand our understanding of how specific foods affect health-associated outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/29046 UR - https://www.researchprotocols.org/2021/10/e29046 UR - http://dx.doi.org/10.2196/29046 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612840 ID - info:doi/10.2196/29046 ER - TY - JOUR AU - Kim, Bokyung AU - Hong, Seoyeon AU - Kim, Sungwook PY - 2021/9/29 TI - Introducing an Integrated Model of Adults? Wearable Activity Tracker Use and Obesity Information?Seeking Behaviors From a National Quota Sample Survey JO - JMIR Form Res SP - e23237 VL - 5 IS - 9 KW - wearable activity tracker KW - wearable health technology KW - obesity KW - health belief KW - health belief model KW - Technology Acceptance Model KW - online information seeking N2 - Background: Research from multiple perspectives to investigate adults? use of wearable activity-tracking devices is limited. We offer a multiperspective model and provide empirical evidence of what leads to frequent usage of wearable health technologies from a large, nationally representative survey sample. Objective: This study aims to explore factors affecting the use of wearable activity-tracking devices among health consumers from the perspectives of individual health beliefs (perceived severity, perceived susceptibility, perceived benefits, and self-efficacy) and information-seeking behaviors. Methods: Our Integrated Model of Wearable Activity Tracker (IMWAT) use and proposed hypotheses were validated and tested with data collected from a telephone survey with a national quota sample. The data were analyzed using a variety of statistical techniques, including structural equation analysis. Results: The sample comprised 2006 participants. Our results showed that the perceived benefits of physical activity, perceived susceptibility, and self-efficacy toward obesity were significant predictors of information-seeking behaviors, which, in turn, mediated their effects on the use of wearable activity trackers. Perceptions of obesity severity directly promoted wearable device usage. Conclusions: This study provided a new and powerful theoretical model that combined the health beliefs and information-seeking behaviors behind the use of wearable activity trackers in the adult population. The findings provide meaningful implications for developers and designers of wearable health technology products and will assist health informatics practitioners and obesity prevention communicators. UR - https://formative.jmir.org/2021/9/e23237 UR - http://dx.doi.org/10.2196/23237 UR - http://www.ncbi.nlm.nih.gov/pubmed/34586076 ID - info:doi/10.2196/23237 ER - TY - JOUR AU - Hanson, Petra AU - Summers, Charlotte AU - Panesar, Arjun AU - Oduro-Donkor, Dominic AU - Lange, Maria AU - Menon, Vinod AU - Barber, M. Thomas PY - 2021/9/23 TI - Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation JO - JMIR Form Res SP - e29110 VL - 5 IS - 9 KW - obesity KW - low carb program KW - eHealth KW - mobile app KW - digital health KW - health intervention KW - mobile health KW - COVID-19 N2 - Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre?COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre?COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. UR - https://formative.jmir.org/2021/9/e29110 UR - http://dx.doi.org/10.2196/29110 UR - http://www.ncbi.nlm.nih.gov/pubmed/34449405 ID - info:doi/10.2196/29110 ER - TY - JOUR AU - Engler-Stringer, Rachel AU - Black, Jennifer AU - Muhajarine, Nazeem AU - Martin, Wanda AU - Gilliland, Jason AU - McVittie, Janet AU - Kirk, Sara AU - Wittman, Hannah AU - Mousavi, Amin AU - Elliott, Sinikka AU - Tu, Sylvana AU - Hills, Brent AU - Androsoff, Gordon AU - Field, Debbie AU - Macdonald, Brit AU - Belt, Chelsea AU - Vatanparast, Hassan PY - 2021/9/21 TI - The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study JO - JMIR Res Protoc SP - e30899 VL - 10 IS - 9 KW - school food programs KW - Canada KW - nutrition KW - intervention research KW - mHealth N2 - Background: Good nutrition affects children?s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children?s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. Objective: The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. Methods: This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. Results: This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. Conclusions: The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. International Registered Report Identifier (IRRID): DERR1-10.2196/30899 UR - https://www.researchprotocols.org/2021/9/e30899 UR - http://dx.doi.org/10.2196/30899 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546171 ID - info:doi/10.2196/30899 ER - TY - JOUR AU - Bhawra, Jasmin AU - Skinner, Kelly AU - Favel, Duane AU - Green, Brenda AU - Coates, Ken AU - Katapally, Reddy Tarun PY - 2021/9/15 TI - The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness JO - JMIR Res Protoc SP - e31389 VL - 10 IS - 9 KW - food security KW - food sovereignty KW - food equity KW - mental health KW - solastalgia KW - climate change impacts KW - climate change preparedness KW - digital health KW - digital dashboards KW - Indigenous health KW - mobile phone N2 - Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change?related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change?related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic Métis jurisdiction of Île-à-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples? self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 UR - https://www.researchprotocols.org/2021/9/e31389 UR - http://dx.doi.org/10.2196/31389 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524106 ID - info:doi/10.2196/31389 ER - TY - JOUR AU - Tully, Louise AU - Sorensen, Jan AU - O'Malley, Grace PY - 2021/9/14 TI - Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial JO - JMIR Mhealth Uhealth SP - e31621 VL - 9 IS - 9 KW - childhood obesity KW - pediatric weight management KW - economic evaluation KW - digital health KW - telemedicine KW - mHealth N2 - Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at ?142 (SD 23.7), whereas the cost per adolescent in the mHealth group was ?722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=?0.7525. The costs incurred for those who withdrew from the study ranged from ?35 to ?681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at ?59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855 UR - https://mhealth.jmir.org/2021/9/e31621 UR - http://dx.doi.org/10.2196/31621 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519665 ID - info:doi/10.2196/31621 ER - TY - JOUR AU - van der Windt, Melissa AU - Schoenmakers, Sam AU - Willemsen, Sten AU - van Rossem, Lenie AU - Steegers-Theunissen, Régine PY - 2021/9/3 TI - Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e28600 VL - 10 IS - 9 KW - eHealth KW - periconception period KW - lifestyle intervention KW - maternal and child health KW - pregnancy KW - birth outcomes KW - healthy lifestyle KW - psychotherapy KW - obesity KW - randomized controlled trial KW - behavior change N2 - Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI?25 and who are contemplating pregnancy or are already pregnant (?12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI?25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI?25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 UR - https://www.researchprotocols.org/2021/9/e28600 UR - http://dx.doi.org/10.2196/28600 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477561 ID - info:doi/10.2196/28600 ER - TY - JOUR AU - Mohd Hanim, Faiz Muhammad AU - Md Sabri, Aslinie Budi AU - Yusof, Norashikin PY - 2021/8/18 TI - Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis JO - JMIR Public Health Surveill SP - e24523 VL - 7 IS - 8 KW - sugar-sweetened beverages KW - obesity KW - taxes KW - media content analysis KW - public health policy KW - media content KW - public health KW - netnography KW - malaysia KW - budget N2 - Background: In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback. Objective: This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation. Methods: Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement. Results: A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8%) and highlighted its health impacts (76%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax?s impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry. Conclusions: The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax. UR - https://publichealth.jmir.org/2021/8/e24523 UR - http://dx.doi.org/10.2196/24523 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406125 ID - info:doi/10.2196/24523 ER - TY - JOUR AU - Swain, Dharitri AU - Begum, Jasmina AU - Parida, Prangnan Swayam PY - 2021/8/16 TI - Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e28148 VL - 10 IS - 8 KW - preconception care KW - maternal nutritional status KW - birth outcome KW - paternal preconception health KW - childbirth KW - birth outcomes KW - maternal and child health KW - maternal health KW - maternal and child nutrition KW - health education KW - pediatrics N2 - Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India?s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry?India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 UR - https://www.researchprotocols.org/2021/8/e28148 UR - http://dx.doi.org/10.2196/28148 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398798 ID - info:doi/10.2196/28148 ER - TY - JOUR AU - Liu, Natalie AU - Birstler, Jen AU - Venkatesh, Manasa AU - Hanrahan, Lawrence AU - Chen, Guanhua AU - Funk, Luke PY - 2021/8/9 TI - Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study JO - J Med Internet Res SP - e24017 VL - 23 IS - 8 KW - obesity KW - body mass index (BMI) KW - risk factors KW - screening KW - health services KW - chronic disease N2 - Background: Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective: The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Methods: US adults aged 18-75 years who had ?3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index. Results: We included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2). Conclusions: The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised. UR - https://www.jmir.org/2021/8/e24017 UR - http://dx.doi.org/10.2196/24017 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383661 ID - info:doi/10.2196/24017 ER - TY - JOUR AU - Weber, J. Summer AU - Shearer, Elyse AU - Mulvaney, A. Shelagh AU - Schmidt, Douglas AU - Thompson, Chris AU - Jones, Jessica AU - Ahmad, Haseeb AU - Coe, Martina AU - Hull, C. Pamela PY - 2021/7/30 TI - Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach JO - JMIR Form Res SP - e30450 VL - 5 IS - 7 KW - WIC KW - mobile technology KW - maternal-child health KW - childhood obesity KW - nutrition KW - government programs KW - mobile app KW - user-centered design KW - low income KW - women KW - infant KW - child KW - formative KW - development N2 - Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. UR - https://formative.jmir.org/2021/7/e30450 UR - http://dx.doi.org/10.2196/30450 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328432 ID - info:doi/10.2196/30450 ER - TY - JOUR AU - Lim, Crystal AU - Rutledge, Laura AU - Sandridge, Shanda AU - King, Krista AU - Jefferson, Darryl AU - Tucker, Tanya PY - 2021/7/28 TI - Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study JO - JMIR Res Protoc SP - e29858 VL - 10 IS - 7 KW - digital health KW - eHealth KW - obesity KW - pediatric obesity KW - pediatrics KW - remote patient monitoring KW - telemedicine KW - weight management N2 - Background: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results: We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID): DERR1-10.2196/29858 UR - https://www.researchprotocols.org/2021/7/e29858 UR - http://dx.doi.org/10.2196/29858 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319245 ID - info:doi/10.2196/29858 ER - TY - JOUR AU - Mottas, Antoine AU - Lappi, Veli-Matti AU - Sundström, Johan AU - Neal, Bruce AU - Mhurchu, Ni Cliona AU - Löf, Marie AU - Rådholm, Karin PY - 2021/7/22 TI - Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden JO - JMIR Mhealth Uhealth SP - e17780 VL - 9 IS - 7 KW - breakfast cereals KW - child-targeted cereals KW - front-of-pack labels KW - Keyhole symbol KW - Health Star Rating KW - FoodSwitch KW - diet KW - food intake N2 - Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals. UR - https://mhealth.jmir.org/2021/7/e17780 UR - http://dx.doi.org/10.2196/17780 UR - http://www.ncbi.nlm.nih.gov/pubmed/34292165 ID - info:doi/10.2196/17780 ER - TY - JOUR AU - Beres, K. Laura AU - Mbabali, Ismail AU - Anok, Aggrey AU - Katabalwa, Charles AU - Mulamba, Jeremiah AU - Thomas, G. Alvin AU - Bugos, Eva AU - Nakigozi, Gertrude AU - Grabowski, K. Mary AU - Chang, W. Larry PY - 2021/7/20 TI - Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e22693 VL - 5 IS - 7 KW - ecological momentary assessment KW - ecological momentary intervention KW - mHealth KW - digital health KW - smartphone KW - mobile phone KW - randomized trial KW - Uganda KW - Africa N2 - Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual?s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non?long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non?long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 UR - https://formative.jmir.org/2021/7/e22693 UR - http://dx.doi.org/10.2196/22693 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283027 ID - info:doi/10.2196/22693 ER - TY - JOUR AU - Fanning, Jason AU - Brooks, K. Amber AU - Hsieh, L. Katherine AU - Kershner, Kyle AU - Furlipa, Joy AU - Nicklas, J. Barbara AU - Rejeski, Jack W. PY - 2021/7/19 TI - Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial JO - JMIR Res Protoc SP - e29013 VL - 10 IS - 7 KW - aging KW - physical activity KW - sedentary behavior KW - weight loss KW - chronic pain KW - mHealth N2 - Background: Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults? chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program?s scalability and potential efficacy. Objective: The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods: The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory?based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results: Recruitment is ongoing as of January 2021. Conclusions: Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration: ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID): PRR1-10.2196/29013 UR - https://www.researchprotocols.org/2021/7/e29013 UR - http://dx.doi.org/10.2196/29013 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279241 ID - info:doi/10.2196/29013 ER - TY - JOUR AU - Odunitan-Wayas, A. Feyisayo AU - Wadende, Pamela AU - Mogo, I. Ebele R. AU - Brugulat-Panés, Anna AU - Micklesfield, K. Lisa AU - Govia, Ishtar AU - Mapa-Tassou, Clarisse AU - Mukoma, Gudani AU - Smith, A. Joanne AU - Motlhalhedi, Molebogeng AU - Wasnyo, Yves AU - Were, Vincent AU - Assah, Felix AU - Okop, J. Kufre AU - Norris, A. Shane AU - Obonyo, Charles AU - Mbanya, Claude Jean AU - Tulloch-Reid, K. Marshall AU - King, C. Abby AU - Lambert, V. Estelle AU - Oni, Tolu PY - 2021/7/13 TI - Adolescent Levers for a Diet and Physical Activity Intervention Across Socioecological Levels in Kenya, South Africa, Cameroon, and Jamaica: Mixed Methods Study Protocol JO - JMIR Res Protoc SP - e26739 VL - 10 IS - 7 KW - adolescent KW - food intake KW - foodways KW - physical activity KW - noncommunicable diseases KW - socioecological levers KW - low and middle income countries KW - health outcomes N2 - Background: The increasing burden of noncommunicable diseases that are prevalent in low- and middle-income countries (LMICs) is largely attributed to modifiable behavioral risk factors such as unhealthy diets and insufficient physical activity (PA). The adolescent stage, defined as 10 to 24 years of age, is an important formative phase of life and offers an opportunity to reduce the risk of noncommunicable diseases across the life course and for future generations. Objective: The aim of this paper is to describe a protocol for a study using a convergent mixed methods design to explore exposures in the household, neighborhood, school, and the journey from home to school that may influence diet and PA behaviors in adolescents from LMICs. Methods: Male and female adolescents (n?150) aged between 13 and 24 years will be recruited from selected high schools or households in project site countries to ensure the socioeconomic diversity of perspectives and experiences at the individual, home, and neighborhood levels. The project will be conducted at 5 sites in 4 countries: Kenya, Cameroon, Jamaica, and South Africa (Cape Town and Johannesburg). Data on anthropometric measures, food intake, and PA knowledge and behavior will be collected using self-report questionnaires. In addition, a small number of learners (n=30-45) from each site will be selected as citizen scientists to capture data (photographs, audio notes, text, and geolocations) on their lived experiences in relation to food and PA in their homes, the journey to and from school, and the school and neighborhood environments using a mobile app, and for objective PA measurements. In-depth interviews will be conducted with the citizen scientists and their caregivers to explore household experiences and determinants of food intake and foodways, as well as the PA of household members. Results: The study described in this protocol paper was primarily funded through a UK National Institute for Health Research grant in 2017 and approved by the relevant institutional ethics review boards in the country sites (South Africa, Cameroun, and Jamaica in 2019, and Kenya in 2020). As of December 23, 2020, we had completed data collection from adolescents (n?150) in all the country sites, except Kenya, and data collection for the subgroup (n=30-45) is ongoing. Data analysis is ongoing and the output of findings from the study described in this protocol is expected to be published by 2022. Conclusions: This project protocol contributes to research that focuses on adolescents and the socioecological determinants of food intake and PA in LMIC settings. It includes innovative methodologies to interrogate and map the contexts of these determinants and will generate much-needed data to understand the multilevel system of factors that can be leveraged through upstream and downstream strategies and interventions to improve health outcomes. International Registered Report Identifier (IRRID): DERR1-10.2196/26739 UR - https://www.researchprotocols.org/2021/7/e26739 UR - http://dx.doi.org/10.2196/26739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255729 ID - info:doi/10.2196/26739 ER - TY - JOUR AU - Kelly, Bridget AU - Bosward, Rebecca AU - Freeman, Becky PY - 2021/7/12 TI - Australian Children's Exposure to, and Engagement With, Web-Based Marketing of Food and Drink Brands: Cross-sectional Observational Study JO - J Med Internet Res SP - e28144 VL - 23 IS - 7 KW - food KW - beverage KW - marketing KW - online KW - digital N2 - Background: Food is one of the most frequently promoted commodities, and promoted foods are overwhelmingly unhealthy. Marketing normalizes unhealthy foods, creates a positive brand image, and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on web-based media, and measuring actual exposure is challenging. Objective: This study aims to monitor the extent of children?s exposure to web-based media food marketing as an essential step in increasing the accountability of industry and governments to protect children. Methods: Children aged 13-17 years were recruited from October 2018 to March 2019. Children recorded their mobile device screen for 2 weekdays and 1 weekend day any time they visited relevant web-based platforms. After each day, the participants uploaded the video files to a secure server. Promoted products were defined using the World Health Organization European Region nutrient profile model. Results: The sample of 95 children uploaded 267.8 hours of video data. Children saw a median of 17.4 food promotions each hour on the internet. Considering the usual time spent on the internet on mobile devices, children would be exposed to a median of 168.4 food promotions on the web on mobile devices per week, 99.5 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (2613/4446, 58.77%) were peer endorsed and derived from third-party sources. Conclusions: Exposure to brand content that is seemingly endorsed by peers or web-based communities likely heightens the effects of marketing on children. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through web-based communities and influencers. UR - https://www.jmir.org/2021/7/e28144 UR - http://dx.doi.org/10.2196/28144 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255675 ID - info:doi/10.2196/28144 ER - TY - JOUR AU - Filos, Dimitris AU - Lekka, Irini AU - Kilintzis, Vasileios AU - Stefanopoulos, Leandros AU - Karavidopoulou, Youla AU - Maramis, Christos AU - Diou, Christos AU - Sarafis, Ioannis AU - Papapanagiotou, Vasileios AU - Alagialoglou, Leonidas AU - Ioakeimidis, Ioannis AU - Hassapidou, Maria AU - Charmandari, Evangelia AU - Heimeier, Rachel AU - O'Malley, Grace AU - O?Donnell, Shane AU - Doyle, Gerardine AU - Delopoulos, Anastasios AU - Maglaveras, Nicos PY - 2021/7/9 TI - Exploring Associations Between Children?s Obesogenic Behaviors and the Local Environment Using Big Data: Development and Evaluation of the Obesity Prevention Dashboard JO - JMIR Mhealth Uhealth SP - e26290 VL - 9 IS - 7 KW - public health authorities KW - childhood obesity KW - children?s behavior KW - environment KW - COVID-19 KW - big data KW - mHealth KW - uHealth KW - intervention N2 - Background: Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project ?BigO: Big Data Against Childhood Obesity? aims to tackle childhood obesity by creating new sources of evidence based on big data. Objective: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app. Methods: The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children?s obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard?s functionality was evaluated during a focus group discussion with public health experts. Results: The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children?s eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children?s physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard?s potential to aid in a better understanding of the interplay between children?s obesogenic behaviors and the environment, and improvements were suggested. Conclusions: Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment. UR - https://mhealth.jmir.org/2021/7/e26290 UR - http://dx.doi.org/10.2196/26290 UR - http://www.ncbi.nlm.nih.gov/pubmed/34048353 ID - info:doi/10.2196/26290 ER - TY - JOUR AU - Shen, Chen AU - Dumontheil, Iroise AU - Thomas, Michael AU - Röösli, Martin AU - Elliott, Paul AU - Toledano, Mireille PY - 2021/7/5 TI - Digital Technology Use and BMI: Evidence From a Cross-sectional Analysis of an Adolescent Cohort Study JO - J Med Internet Res SP - e26485 VL - 23 IS - 7 KW - adolescent KW - digital technology KW - obesity KW - insufficient sleep KW - mediation analysis KW - mobile phone N2 - Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep. Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents. Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep. Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted ?=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (?30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect. Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships. UR - https://www.jmir.org/2021/7/e26485 UR - http://dx.doi.org/10.2196/26485 UR - http://www.ncbi.nlm.nih.gov/pubmed/35143408 ID - info:doi/10.2196/26485 ER - TY - JOUR AU - Benavides, Lynn Heidi AU - Meireles, Lumachi Christiane AU - Benavente, Viola AU - Mays, Helen Mary AU - Wang, Jing PY - 2021/7/5 TI - Decreasing COVID-19 Risk Factors for Older Adults by Using Digital Technology to Implement a Plant-Based-Diet: An Opinion JO - JMIR Aging SP - e25327 VL - 4 IS - 3 KW - COVID-19 KW - coronavirus KW - older adult KW - plant-based diet KW - eating patterns KW - whole foods KW - Mediterranean diet KW - obesity KW - pandemic KW - ethnic minorities KW - telehealth KW - digital technology KW - racial disparities KW - aging UR - https://aging.jmir.org/2021/3/e25327 UR - http://dx.doi.org/10.2196/25327 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081595 ID - info:doi/10.2196/25327 ER - TY - JOUR AU - Milne-Ives, Madison AU - Swancutt, Dawn AU - Burns, Lorna AU - Pinkney, Jonathan AU - Tarrant, Mark AU - Calitri, Raff AU - Chatterjee, Arunangsu AU - Meinert, Edward PY - 2021/6/30 TI - The Effectiveness and Usability of Online, Group-Based Interventions for People With Severe Obesity: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e26619 VL - 10 IS - 6 KW - internet-based interventions KW - telemedicine KW - group-based interventions KW - obesity KW - severe obesity KW - obesity management KW - weight loss KW - weight reduction programs KW - diet therapy KW - exercise KW - systematic review KW - weight management N2 - Background: Globally, obesity is a growing crisis. Despite obesity being preventable, over a quarter of the UK adult population is currently considered clinically obese (typically body mass index ?35 kg/m2). Access to treatment for people with severe obesity is limited by long wait times and local availability. Online and group-based interventions provide means of increasing the accessibility of obesity prevention and treatment services. However, there has been no prior review of the effectiveness of group-based interventions delivered online for people with severe obesity. Objective: The purpose of this systematic review protocol is to provide an evaluation of the effectiveness and usability of different types of online, group-based interventions for people with severe obesity. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks were used to structure this review. The review will systematically search 7 databases: MEDLINE, Embase, the Cumulative Index of Nursing and Allied Health Literature, APA PsycNet, Web of Science, CENTRAL, and the ProQuest Dissertations and Theses databases. Two authors (MM-I and LB) will independently screen the titles and abstracts of identified articles, select studies for inclusion based on the eligibility criteria, and extract data into a standardized form. Any disagreements will be discussed and resolved by a third reviewer (EM) if necessary. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 tool and a descriptive analysis will be used to evaluate effectiveness and usability. Results: The systematic review has not yet been started. It is expected to be completed and submitted for publication by December 2021. Conclusions: This systematic review will summarize the effectiveness and usability of online, group-based interventions for people with obesity. It will identify the types of online delivery that have the strongest support to help inform the development of more useful and engaging interventions for people with severe obesity. Trial Registration: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101 International Registered Report Identifier (IRRID): PRR1-10.2196/26619 UR - https://www.researchprotocols.org/2021/6/e26619 UR - http://dx.doi.org/10.2196/26619 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255710 ID - info:doi/10.2196/26619 ER - TY - JOUR AU - Vuorinen, Anna-Leena AU - Helander, Elina AU - Pietilä, Julia AU - Korhonen, Ilkka PY - 2021/6/28 TI - Frequency of Self-Weighing and Weight Change: Cohort Study With 10,000 Smart Scale Users JO - J Med Internet Res SP - e25529 VL - 23 IS - 6 KW - self-monitoring KW - self-weighing KW - weight change, weight loss, normal weight, overweight, obese, temporal weight change N2 - Background: Frequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings. Objective: This study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users. Methods: This was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson?s correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models. Results: The eligible sample consisted of 9768 participants (6515/9768, 66.7% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0%), 3748 (3748/9768, 38.4%), and 2017 (2017/9768, 20.6%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was ?0.59 kg, and the mean percentage of days with a self-weigh was 39.98%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, r=?0.111 (P<.001). Among normal weight, overweight, and obese individuals, the correlations were r=?0.100 (P<.001), r=?0.125 (P<.001), and r=?0.148 (P<.001), respectively. Of all participants, 72.5% (7085/9768) had at least one period of ?30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (P<.001). Conclusions: Frequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals. UR - https://www.jmir.org/2021/6/e25529 UR - http://dx.doi.org/10.2196/25529 UR - http://www.ncbi.nlm.nih.gov/pubmed/34075879 ID - info:doi/10.2196/25529 ER - TY - JOUR AU - Sutherland, Rachel AU - Brown, Alison AU - Nathan, Nicole AU - Yoong, Serene AU - Janssen, Lisa AU - Chooi, Amelia AU - Hudson, Nayerra AU - Wiggers, John AU - Kerr, Nicola AU - Evans, Nicole AU - Gillham, Karen AU - Oldmeadow, Christopher AU - Searles, Andrew AU - Reeves, Penny AU - Davies, Marc AU - Reilly, Kathryn AU - Cohen, Brad AU - Wolfenden, Luke PY - 2021/6/24 TI - A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness?Implementation Hybrid Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e25256 VL - 23 IS - 6 KW - childhood obesity KW - lunchboxes KW - children KW - child nutrition KW - mHealth KW - schools KW - hybrid KW - randomized controlled trial KW - technology N2 - Background: There is significant opportunity to improve the nutritional quality of foods packed in children?s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health?based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness?implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children?s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (?117.26 kJ; 95% CI ?195.59 to ?39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (?88.38 kJ; 95% CI ?172.84 to ?3.92; P=.04) and consumed (?117.17 kJ; 95% CI ?233.72 to ?0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children?s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school?aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school?aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x UR - https://www.jmir.org/2021/6/e25256/ UR - http://dx.doi.org/10.2196/25256 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185013 ID - info:doi/10.2196/25256 ER - TY - JOUR AU - van der Haar, Sandra AU - Hoevenaars, M. Femke P. AU - van den Brink, J. Willem AU - van den Broek, Tim AU - Timmer, Mariëlle AU - Boorsma, André AU - Doets, L. Esmée PY - 2021/6/24 TI - Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study JO - JMIR Form Res SP - e25043 VL - 5 IS - 6 KW - personalized nutrition KW - metabolic syndrome KW - dietary behavior KW - diet KW - metabolic KW - metabolic health KW - dietary advice KW - dietary feedback KW - digital health N2 - Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 UR - https://formative.jmir.org/2021/6/e25043/ UR - http://dx.doi.org/10.2196/25043 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185002 ID - info:doi/10.2196/25043 ER - TY - JOUR AU - Hendrie, A. Gilly AU - Baird, L. Danielle AU - Brindal, Emily AU - Williams, Gemma AU - Brand-Miller, Jennie AU - Muhlhausler, Beverly PY - 2021/6/7 TI - Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort JO - J Med Internet Res SP - e20981 VL - 23 IS - 6 KW - obesity KW - obesity management KW - weight loss KW - internet-based intervention N2 - Background: Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss. Objective: This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years. Methods: Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: ?stayers? were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while ?starters? began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss. Results: Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (?=.263; P<.001), with higher usage associated with greater weight loss. Conclusions: This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant. UR - https://www.jmir.org/2021/6/e20981 UR - http://dx.doi.org/10.2196/20981 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096869 ID - info:doi/10.2196/20981 ER - TY - JOUR AU - Vandormael, Alain AU - Adam, Maya AU - Hachaturyan, Violetta AU - Greuel, Merlin AU - Favaretti, Caterina AU - Gates, Jennifer AU - Baernighausen, Till PY - 2021/5/28 TI - Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial JO - JMIR Res Protoc SP - e25343 VL - 10 IS - 5 KW - entertainment-education KW - sugar reduction KW - reactance KW - animated video KW - list experiment N2 - Background: Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message?a phenomenon known as reactance. Objective: In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child?s mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator?s perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants? interest in watching the entertainment-education intervention video. Methods: This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video. Results: The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021. Conclusions: In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs. Trial Registration: German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340. International Registered Report Identifier (IRRID): DERR1-10.2196/25343 UR - https://www.researchprotocols.org/2021/5/e25343 UR - http://dx.doi.org/10.2196/25343 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047702 ID - info:doi/10.2196/25343 ER - TY - JOUR AU - Joseph, P. Rodney AU - Vega-López, Sonia AU - Han, SeungYong PY - 2021/5/17 TI - Physical Activity Patterns and Neighborhood Characteristics of First-Generation Latina Immigrants Living in Arizona: Cross-sectional Study JO - JMIR Form Res SP - e25663 VL - 5 IS - 5 KW - emigrants and immigrants KW - physical activity KW - exercise KW - residence characteristics KW - female KW - metabolic disease KW - Latina KW - immigrants KW - emigrants KW - health outcomes N2 - Background: Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective: The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods: Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results: Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95% CI 1.49-23.74; 2.45, 95% CI 1.01-5.93; and 3.30, 95% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95% CI 1.13-15.18; 6.43, 95% CI 1.45-28.39; and 2.53, 95% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions: Although most participants met national PA guidelines (ie, ?500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA. UR - https://formative.jmir.org/2021/5/e25663 UR - http://dx.doi.org/10.2196/25663 UR - http://www.ncbi.nlm.nih.gov/pubmed/33999003 ID - info:doi/10.2196/25663 ER - TY - JOUR AU - Karssen, T. Levie AU - Vink, M. Jacqueline AU - de Weerth, Carolina AU - Hermans, J. Roel C. AU - de Kort, M. Carina P. AU - Kremers, PJ Stef AU - Ruiter, M. Emilie L. AU - Larsen, K. Junilla PY - 2021/5/14 TI - An App-Based Parenting Program to Promote Healthy Energy Balance?Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework JO - JMIR Form Res SP - e24802 VL - 5 IS - 5 KW - childhood obesity KW - preventive intervention KW - parenting practices KW - energy-balance related behavior KW - socio-economic position KW - mHealth KW - behavior change KW - mobile phone N2 - Background: The family environment plays an important role in the development of children?s energy balance?related behaviors. As a result, parents? energy balance?related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance?related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance?related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance?related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. UR - https://formative.jmir.org/2021/5/e24802 UR - http://dx.doi.org/10.2196/24802 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988510 ID - info:doi/10.2196/24802 ER - TY - JOUR AU - Bhatti, Rahila AU - Warshow, Usama AU - Joumaa, Mona AU - ElSaban, Mariam AU - Nawaz, A. Faisal AU - Khamis, Hassan Amar PY - 2021/5/13 TI - Relevance of Anthropometric Measurements in a Multiethnic Obesity Cohort: Observational Study JO - Interact J Med Res SP - e27784 VL - 10 IS - 2 KW - anthropometrics KW - body mass index KW - cardiovascular health KW - comorbidities KW - liver disease KW - obesity KW - overweight KW - type 2 diabetes mellitus KW - visceral fat KW - waist circumference KW - weight loss KW - weight management N2 - Background: The prevalence of obesity is increasing worldwide, and the Middle East is not an exception to this increasing trend. Obesity increases the risk of multiple metabolic complications, such as diabetes mellitus. Measurement of obesity has primarily relied on the BMI to identify risk; however, both bedside and office-based anthropometric measures of obesity can provide more detailed information on risk. Objective: This study aimed to investigate the prevalence of obesity-related diseases in a multidisciplinary weight management population and to determine its relationship with obesity anthropometric indices. Methods: This cross-sectional study was conducted at Mediclinic Parkview Hospital (Dubai, the United Arab Emirates). In total, 308 patients have been evaluated from January to September 2019 as part of a multidisciplinary weight management program. Key demographics, anthropometrics, and clinical data were analyzed using SPSS (version 25, SPSS Inc). Results: Our cohort of 308 patients included 103 (33%) males and 205 (67%) females of 38 nationalities. The mean age of the cohort was 41 (SD 9.6) years, with a median BMI of 34.5 (IQR 6.7) and 33.7 (IQR 7.8) for males and females, respectively. The mean waist circumference (WC) was 113.4 (SD 23.3) cm and 103.5 (SD 16.2) cm, fat percentage was 33.7% (SD 11.6%) and 45% (SD 6.8%), fat mass was 41 (SD 15.2) kg and 41.1 (SD 14.1) kg, and visceral fat mass was 6.5 (SD 3.2) kg and 3.1 (SD 1.8) kg for males and females, respectively. There was a strong correlation between BMI and WC (r=0.65 and r=0.69 in males and females, respectively; P=.01) and visceral fat (r=0.78 and r=0.90 in males and females, respectively). Furthermore, visceral fat was significantly associated with WC in both sexes (r=0.73 and r=0.68 in females and males respectively; P=.01). Furthermore, WC was significantly associated with a risk of diabetes, hypertension, and nonalcoholic fatty liver disease. Conclusions: BMI and WC are the most representative measures of obesity in our population and correlate with abdominal adiposity? and obesity-related diseases. Further studies are required to assess the benefits of these measures during weight reduction interventions. UR - https://www.i-jmr.org/2021/2/e27784 UR - http://dx.doi.org/10.2196/27784 UR - http://www.ncbi.nlm.nih.gov/pubmed/33983128 ID - info:doi/10.2196/27784 ER - TY - JOUR AU - Graham, K. Andrea AU - Munson, A. Sean AU - Reddy, Madhu AU - Neubert, W. Sarah AU - Green, A. Emilie AU - Chang, Angela AU - Spring, Bonnie AU - Mohr, C. David AU - Wildes, E. Jennifer PY - 2021/5/10 TI - Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis JO - JMIR Form Res SP - e23809 VL - 5 IS - 5 KW - obesity KW - binge eating KW - user-centered design KW - mobile intervention KW - engagement KW - experimental therapeutics N2 - Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (?12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (?2.2 [SD ?5.0] pounds) and binge eating (?1.6 [SD ?1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. UR - https://formative.jmir.org/2021/5/e23809 UR - http://dx.doi.org/10.2196/23809 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970114 ID - info:doi/10.2196/23809 ER - TY - JOUR AU - Yong, Y. Joceline Y. AU - Tong, W. Eddie M. AU - Liu, J. Jean C. PY - 2021/5/6 TI - Meal-time Smartphone Use in an Obesogenic Environment: Two Longitudinal Observational Studies JO - JMIR Mhealth Uhealth SP - e22929 VL - 9 IS - 5 KW - screen time KW - mobile phones KW - technology KW - obesogenic environment KW - young adults N2 - Background: Despite a large volume of research on the impact of other digital screens (eg, televisions) on eating behavior, little is known about the nature and impact of mealtime smartphone use. Objective: We investigated how smartphones are used in everyday meals, whether phone users differ according to mealtime phone use patterns, and whether specific phone functions (particularly food photography) would affect the amount and enjoyment of food eaten. Methods: Across 2 studies, we used the experience sampling method to track 1780 meals in situ. In study 1, a total 137 young adults reported on their mealtime smartphone use 3 times per day over 7 consecutive days. This corresponded to each main meal, with participants recording whether they used their phones and what phone functions they engaged in while eating. In study 2, a total of 71 young adults were similarly tracked for 3 meals per day over 7 days. Across the week, participants? meals were randomized to 1 of 3 smartphone conditions: food photography while eating, nonfood photography while eating, or no phone use. As the outcome measures, participants reported on the amount and enjoyment of food they ate. Results: During the week-long tracking, most participants (110/129, 85.3%) recorded at least one instance of mealtime smartphone use, with an average frequency of 1 in 3 meals where phones were used (27.1%; 95% CI 23.6-30.6). Unlike traditional digital screens, mealtime phone use encompassed a wide range of social and nonsocial activities. Further, specific forms of phone use behaviors influenced food intake in different ways. Specifically, in study 2, participants showed the typical pattern of increased food intake across the day when they engaged in nonfood photography during a meal (P<.001); however, this pattern was disrupted when they engaged in food photography (P=.73). Conclusions: Our findings underscore the prevalence and multifaceted nature of mealtime phone use, distinguishing mobile phones from traditional forms of digital screens. Trial Registration: ClinicalTrials.gov NCT03299075; https://www.clinicaltrials.gov/ct2/show/NCT03299075 and ClinicalTrials.gov NCT03346785; https://clinicaltrials.gov/ct2/show/NCT03346785 UR - https://mhealth.jmir.org/2021/5/e22929 UR - http://dx.doi.org/10.2196/22929 UR - http://www.ncbi.nlm.nih.gov/pubmed/33955842 ID - info:doi/10.2196/22929 ER - TY - JOUR AU - Fahey, C. Margaret AU - Klesges, C. Robert AU - Kocak, Mehmet AU - Gladney, A. Leslie AU - Talcott, W. Gerald AU - Krukowski, A. Rebecca PY - 2021/5/5 TI - Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis JO - JMIR Form Res SP - e23974 VL - 5 IS - 5 KW - technology-based intervention KW - counselor communication KW - counselor feedback KW - counselor KW - weight loss KW - lifestyle KW - wellness N2 - Background: Feedback for participants? self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. Objective: The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. Methods: The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. Results: There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). Conclusions: Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 UR - https://formative.jmir.org/2021/5/e23974 UR - http://dx.doi.org/10.2196/23974 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949954 ID - info:doi/10.2196/23974 ER - TY - JOUR AU - Wang, Boshi AU - Cheng, Jason Zhangkai AU - Xu, Qian AU - Zhu, Tiangang AU - Su, Lin AU - Xue, Mingshan AU - Pei, Lin AU - Zhu, Li AU - Liu, Peng PY - 2021/5/3 TI - Dietary Structure and Nutritional Status of Chinese Beekeepers: Demographic Health Survey JO - JMIR Public Health Surveill SP - e28726 VL - 7 IS - 5 KW - beekeeper KW - body composition KW - nutrition survey KW - MMSE N2 - Background: Beekeeping and honey gathering are traditional forms of agricultural farming in China. However, only few studies have focused on the nutritional status and health level of this special occupational group. Objective: By comparing the health status of apiculturists (beekeepers) and vegetable farmers in plain areas of Hubei Province, and analyzing the influence of dietary structure and intake on their nutritional level, this paper provides a scientific theoretical basis for the further development of health education and disease prevention for beekeepers. Methods: From February to April 2016, 191/236 beekeepers (80.9% of the total beekeepers) with large-scale breeding (300-500 colonies) and 182 vegetable farmers in the same area were sampled by the cluster sampling method. Their nutrient composition was analyzed using a human body composition analyzer, dietary structure information was collected using the dietary frequency query method, and cognitive function was investigated. In addition, blood samples of both groups were collected. Results: A total of 362 valid questionnaires (beekeepers/vegetable farmers: 185/177) were collected, with an effective response rate of 97.1% (362/373). Both beekeepers and vegetable farmers were overweight, and the beekeepers? grip strength was much stronger than that of the vegetable farmers? regardless of gender. The dietary structure of beekeepers is very unique: 29.7% (55/185) of beekeepers indicated consuming royal jelly regularly for more than 10 years. Their main foods are grain, cereals, and fresh vegetables; 68.1% (126/185) of the beekeepers never drank milk and other dairy products, and their overall nutrient intake is unbalanced. The average intake of cellulose in this group was also significantly higher than that in the epidemiological survey in the same sex and age group. The intake of vitamin A and selenium in the beekeepers group was significantly higher than that in the vegetable-farmers group (all P<.001). The blood indices of creatinine (P=.03) and blood copper (P<.001) in the beekeepers group were significantly higher than those in the vegetable-farmers group, and the total protein, albumin, calcium, sodium, potassium, phosphorus, folic acid, and vitamin B12 in the beekeepers group were significantly lower than those in the vegetable-farmers group (P<.03 for potassium and P<.001 for others). The total Mini-Mental State Examination (MMSE) score of the beekeepers group was 28.1, significantly higher (P=.006) than that of the vegetable-farmers group (23.3). Conclusions: The beekeepers in this area have their special dietary structure, body nutrient level, and disease characteristics. The cognitive level of the beekeepers who regularly consume royal jelly is significantly higher than that of their peers. The chronic diseases of this special occupational group are closely related to their lifestyle and nutritional status, so more attention and in-depth studies are needed to improve the quality of life of this population. UR - https://publichealth.jmir.org/2021/5/e28726 UR - http://dx.doi.org/10.2196/28726 UR - http://www.ncbi.nlm.nih.gov/pubmed/33938812 ID - info:doi/10.2196/28726 ER - TY - JOUR AU - Oladeji, Olubusola AU - Zhang, Chi AU - Moradi, Tiam AU - Tarapore, Dharmesh AU - Stokes, C. Andrew AU - Marivate, Vukosi AU - Sengeh, D. Moinina AU - Nsoesie, O. Elaine PY - 2021/4/29 TI - Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study JO - JMIR Public Health Surveill SP - e24348 VL - 7 IS - 4 KW - obesity KW - overweight KW - Africa KW - chronic diseases KW - hypertension KW - digital phenotype KW - infodemiology KW - infoveillance N2 - Background: The prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors. Objective: The objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa. Methods: We obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance. Results: The study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence. Conclusions: Information-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys. UR - https://publichealth.jmir.org/2021/4/e24348 UR - http://dx.doi.org/10.2196/24348 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913815 ID - info:doi/10.2196/24348 ER - TY - JOUR AU - Gamble, Abigail AU - Beech, M. Bettina AU - Wade, C. Breanna AU - Sutton, D. Victor AU - Lim, Crystal AU - Sandridge, Shanda AU - Welsch, A. Michael PY - 2021/3/31 TI - Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial JO - JMIR Res Protoc SP - e25699 VL - 10 IS - 3 KW - prediabetic state KW - child obesity KW - telehealth KW - obesity management KW - behavioral science KW - implementation science KW - Jackson Heart Study KW - Centers for Disease Control and Prevention KW - preventive medicine KW - mobile phone N2 - Background: In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective: This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center?s (UMMC) pediatric weight management clinic. Methods: This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi?enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC?s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results: Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC?s Institutional Review Board (#2020V0249). Conclusions: The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID): PRR1-10.2196/25699 UR - https://www.researchprotocols.org/2021/3/e25699 UR - http://dx.doi.org/10.2196/25699 UR - http://www.ncbi.nlm.nih.gov/pubmed/33787504 ID - info:doi/10.2196/25699 ER - TY - JOUR AU - Tate, Allan AU - Trofholz, Amanda AU - Miner, Michael AU - Berge, Jerica PY - 2021/3/24 TI - Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study JO - JMIR Pediatr Parent SP - e22541 VL - 4 IS - 1 KW - meal healthfulness KW - direct observation KW - family meals KW - well-being KW - diet KW - food N2 - Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis?St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. UR - https://pediatrics.jmir.org/2021/1/e22541 UR - http://dx.doi.org/10.2196/22541 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759788 ID - info:doi/10.2196/22541 ER - TY - JOUR AU - Wang, Aiwei AU - Gao, Yang AU - Wang, Jingjing AU - Tong, K. Tomas AU - Sun, Yan AU - Yu, Siyue AU - Zhao, Hong AU - Zou, Daozhi AU - Zhang, Ziheng AU - Qi, Yuling AU - Zuo, Nan AU - Bu, Danran AU - Zhang, Dexing AU - Xie, Yaojie AU - Baker, S. Julien PY - 2021/3/22 TI - Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25838 VL - 10 IS - 3 KW - children KW - intellectual disability KW - physical activity KW - overweight KW - obesity KW - intervention N2 - Background: Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers. Objective: The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population. Methods: The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game?based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG. Results: This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021. Conclusions: The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability. Trial Registration: ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355 International Registered Report Identifier (IRRID): PRR1-10.2196/25838 UR - https://www.researchprotocols.org/2021/3/e25838 UR - http://dx.doi.org/10.2196/25838 UR - http://www.ncbi.nlm.nih.gov/pubmed/33749611 ID - info:doi/10.2196/25838 ER - TY - JOUR AU - de Jersey, Susan AU - Meloncelli, Nina AU - Guthrie, Taylor AU - Powlesland, Hilary AU - Callaway, Leonie AU - Chang, T. Angela AU - Wilkinson, Shelley AU - Comans, Tracy AU - Eakin, Elizabeth PY - 2021/3/18 TI - Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study JO - JMIR Res Protoc SP - e27196 VL - 10 IS - 3 KW - implementation study KW - pregnancy KW - weight KW - nutrition KW - lifestyle intervention KW - physical activity N2 - Background: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective: This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods: Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ?16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks? gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results: Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions: This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID): DERR1-10.2196/27196 UR - https://www.researchprotocols.org/2021/3/e27196 UR - http://dx.doi.org/10.2196/27196 UR - http://www.ncbi.nlm.nih.gov/pubmed/33734093 ID - info:doi/10.2196/27196 ER - TY - JOUR AU - Martino, Florentine AU - Brooks, Ruby AU - Browne, Jennifer AU - Carah, Nicholas AU - Zorbas, Christina AU - Corben, Kirstan AU - Saleeba, Emma AU - Martin, Jane AU - Peeters, Anna AU - Backholer, Kathryn PY - 2021/3/12 TI - The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study JO - JMIR Public Health Surveill SP - e25202 VL - 7 IS - 3 KW - alcohol KW - food and beverage KW - COVID-19 KW - marketing KW - social media N2 - Background: Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and ?comfort eating? as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how ?Big Food? and ?Big Alcohol? are capitalizing on the COVID-19 pandemic to market their products and brands. Objective: We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods: We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results: Nearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions: This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. ?COVID-washing? by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to ?build back better? in a post-COVID-19 world. UR - https://publichealth.jmir.org/2021/3/e25202 UR - http://dx.doi.org/10.2196/25202 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709935 ID - info:doi/10.2196/25202 ER - TY - JOUR AU - Schroeder, Alexander Philipp AU - Lohmann, Johannes AU - Ninaus, Manuel PY - 2021/3/12 TI - Preserved Inhibitory Control Deficits of Overweight Participants in a Gamified Stop-Signal Task: Experimental Study of Validity JO - JMIR Serious Games SP - e25063 VL - 9 IS - 1 KW - gamification KW - inhibitory control KW - response inhibition KW - overweight KW - BMI KW - stop-signal task KW - mental health KW - games N2 - Background: Gamification in mental health could increase training adherence, motivation, and transfer effects, but the external validity of gamified tasks is unclear. This study documents that gamified task variants can show preserved associations between markers of behavioral deficits and health-related variables. We draw on the inhibitory control deficit in overweight populations to investigate effects of gamification on performance measures in a web-based experimental task. Objective: This study tested whether associations between inhibitory control and overweight were preserved in a gamified stop-signal task (SST). Methods: Two versions of an adaptive SST were developed and tested in an online experiment. Participants (n=111) were randomized to 1 of the 2 task variants and completed a series of questionnaires along with either the gamified SST or a conventional SST. To maximize its possible effects on participants? inhibitory control, the gamified SST included multiple game elements in addition to the task itself and the stimuli. Both variants drew on the identical core mechanics, but the gamified variant included an additional narrative, graphical theme, scoring system with visual and emotional feedback, and the presence of a companion character. In both tasks, food and neutral low-poly stimuli were classified based on their color tone (go trials), but responses were withheld in 25% of the trials (stop trials). Mean go reaction times and stop-signal reaction times (SSRT) were analyzed as measures of performance and inhibitory control. Results: Participants in the gamified SST had longer reaction times (803 [SD 179] ms vs 607 [SD 90] ms) and worse inhibitory control (SSRT 383 [SD 109] ms vs 297 [SD 45] ms). The association of BMI with inhibitory control was relatively small (r=.155, 95% CI .013-.290). Overweight participants had longer reaction times (752 [SD 217] ms vs 672 [SD 137] ms) and SSRTs (363 [SD 116] ms vs 326 [SD 77] ms). Gamification did not interact with the effect of overweight on mean performance or inhibitory control. There were no effects of gamification on mood and user experience, despite a negative effect on perceived efficiency. Conclusions: The detrimental effects of heightened BMI on inhibitory control were preserved in a gamified version of the SST. Overall, the effects of overweight were smaller than in previously published web-based and laboratory studies. Gamification elements can impact behavioral performance, but gamified tasks can still assess inhibitory control deficits. Although our results are promising, according validations may differ for other types of behavior, gamification, and health variables. UR - https://games.jmir.org/2021/1/e25063 UR - http://dx.doi.org/10.2196/25063 UR - http://www.ncbi.nlm.nih.gov/pubmed/33709936 ID - info:doi/10.2196/25063 ER - TY - JOUR AU - Knowlden, P. Adam AU - Higginbotham, C. John AU - Grandner, A. Michael AU - Allegrante, P. John PY - 2021/3/9 TI - Modeling Risk Factors for Sleep- and Adiposity-Related Cardiometabolic Disease: Protocol for the Short Sleep Undermines Cardiometabolic Health (SLUMBRx) Observational Study JO - JMIR Res Protoc SP - e27139 VL - 10 IS - 3 KW - abdominal obesity-metabolic syndrome KW - adiposity KW - body composition KW - body fat distribution KW - insufficient sleep syndrome KW - observational study KW - short sleeper syndrome KW - sleep deprivation N2 - Background: Obesity and short sleep duration are significant public health issues. Current evidence suggests that these conditions are associated with cardiovascular disease, metabolic syndrome, inflammation, and premature mortality. Increased interest in the potential link between obesity and short sleep duration, and its health consequences, has been driven by the apparent parallel increase in the prevalence of both conditions in recent decades, their overlapping association with cardiometabolic outcomes, and the potential causal connection between the two health issues. The SLUMBRx (Short Sleep Undermines Cardiometabolic Health) study seeks to contribute to the development of a comprehensive adiposity-sleep model while laying the groundwork for a future research program that will be designed to prevent and treat adiposity- and sleep-related cardiometabolic disease risk factors. Objective: This SLUMBRx study aims to address 4 topics pertinent to the adiposity-sleep hypothesis: the relationship between adiposity and sleep duration; sex-based differences in the relationship between adiposity and sleep duration; the influence of adiposity indices and sleep duration on cardiometabolic outcomes; and the role of socioecological factors as effect modifiers in the relationship between adiposity indices, sleep, and cardiometabolic outcomes. Methods: SLUMBRx will employ a large-scale survey (n=1000), recruiting 159 participants (53 normal weight, 53 overweight, and 53 obese) to be assessed in 2 phases. Results: SLUMBRx was funded by the National Institutes of Health, Heart, Lung, and Blood Institute through a K01 grant award mechanism (1K01HL145128-01A1) on July 23, 2019. Institutional Review Board (IRB) approval for the research project was sought and obtained on July 10, 2019. Phase 1 of SLUMBRx, the laboratory-based component of the study, will gather objective adiposity indices (air displacement plethysmography and anthropometrics) and cardiometabolic data (blood pressure, pulse wave velocity and pulse wave analysis, and a blood-based biomarker). Phase 2 of SLUMBRx, a 1-week, home-based component of the study, will gather sleep-related data (home sleep testing or sleep apnea, actigraphy, and sleep diaries). During phase 2, detailed demographic and socioecological data will be collected to contextualize hypothesized adiposity and sleep-associated cardiometabolic disease risk factors. Collection and analyses of these data will yield information necessary to customize future observational and intervention research. Conclusions: Precise implementation of the SLUMBRx protocol promises to provide objective and empirical data on the interaction between body composition and sleep duration. The hypotheses that will be tested by SLUMBRx are important for understanding the pathogenesis of cardiometabolic disease and for developing future public health interventions to prevent its conception and treat its consequences. International Registered Report Identifier (IRRID): PRR1-10.2196/27139 UR - https://www.researchprotocols.org/2021/3/e27139 UR - http://dx.doi.org/10.2196/27139 UR - http://www.ncbi.nlm.nih.gov/pubmed/33687340 ID - info:doi/10.2196/27139 ER - TY - JOUR AU - Schoenberg, Nancy AU - Dunfee, Madeline AU - Yeager, Hannah AU - Rutledge, Matthew AU - Pfammatter, Angela AU - Spring, Bonnie PY - 2021/2/26 TI - Rural Residents? Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews JO - JMIR Form Res SP - e18853 VL - 5 IS - 2 KW - rural populations KW - technology KW - exercise KW - diet KW - community-based participatory research KW - mobile phone N2 - Background: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. Objective: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program?Make Better Choices 2?consists of personalized health coaching, accelerometer use, and financial incentives. Methods: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. Results: We identified 3 main themes regarding Appalachian residents? perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. Conclusions: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents. UR - https://formative.jmir.org/2021/2/e18853 UR - http://dx.doi.org/10.2196/18853 UR - http://www.ncbi.nlm.nih.gov/pubmed/33635278 ID - info:doi/10.2196/18853 ER - TY - JOUR AU - Hoenink, C. Jody AU - Mackenbach, D. Joreintje AU - van der Laan, Nynke Laura AU - Lakerveld, Jeroen AU - Waterlander, Wilma AU - Beulens, J. Joline W. PY - 2021/2/9 TI - Recruitment of Participants for a 3D Virtual Supermarket: Cross-sectional Observational Study JO - JMIR Form Res SP - e19234 VL - 5 IS - 2 KW - online study KW - nudges KW - pricing KW - recruitment strategies N2 - Background: Virtual supermarkets offer a practical and affordable setting to test the efficacy of different pricing and nudging strategies before they are implemented in the real world. Despite the advantages of using virtual supermarkets for this purpose, conducting studies in online settings is challenging with regard to recruitment and retention of sufficient and suitable participants. Objective: To describe cost, time, and retention with regard to participants recruited using various strategies and potential sociodemographic differences between participants recruited via different strategies. Methods: This cross-sectional study used data from a randomized controlled trial in which 455 Dutch adults with low and high educational levels were invited to shop 5 times in a 3D virtual supermarket. Participants were recruited via social media and flyers. A log that tracked the costs of and time spent on the different recruitment strategies was kept by the study team. Outcome measures included the cost of recruitment strategies, the time investment by researchers, and recruitment and attrition rates of participants in the study. Results: The median age of study completers was 31.0 (IQR 25.0) and 157 out of 346 study completers (45.4%) were highly educated. Out of the 455 included participants, 235 (51.6%) were recruited via social media campaigns, 131 (28.8%) via home-delivered flyers, 38 (8.4%) via flyers directly distributed by the study team, and 46 (10.1%) via word-of-mouth. Of all paid recruitment strategies, social media campaigns were the cheapest and least time-consuming, whereas the distribution of flyers by the study team was the most expensive and time-consuming recruitment strategy. Age, sex, overweight status, employment situation, and number of adults within the household varied by recruitment strategy. Conclusions: Using different recruitment strategies resulted in the efficient recruitment of a representative study sample and retention of participants was relatively high. While ?word-of-mouth? was the most cost- and time-effective recruitment strategy, using only one type of recruitment strategy could result in a demographically skewed study population. UR - http://formative.jmir.org/2021/2/e19234/ UR - http://dx.doi.org/10.2196/19234 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560230 ID - info:doi/10.2196/19234 ER - TY - JOUR AU - Gans, M. Kim AU - Dulin, Akilah AU - Palomo, Vanessa AU - Benitez, Tanya AU - Dunsiger, Shira AU - Dionne, Laura AU - Champion, Gregory AU - Edgar, Rachelle AU - Marcus, Bess PY - 2021/1/29 TI - A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial JO - JMIR Res Protoc SP - e23690 VL - 10 IS - 1 KW - physical activity KW - Latino KW - Hispanic KW - men KW - eHealth KW - expert system KW - internet KW - text messaging KW - mobile phone KW - social media N2 - Background: Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men. Objective: To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables. Methods: Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization. Results: This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing. Conclusions: We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message?based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial. Trial Registration: Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID): DERR1-10.2196/23690 UR - http://www.researchprotocols.org/2021/1/e23690/ UR - http://dx.doi.org/10.2196/23690 UR - http://www.ncbi.nlm.nih.gov/pubmed/33512327 ID - info:doi/10.2196/23690 ER - TY - JOUR AU - Kamyari, Naser AU - Soltanian, Reza Ali AU - Mahjub, Hossein AU - Moghimbeigi, Abbas PY - 2021/1/26 TI - Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data JO - JMIR Public Health Surveill SP - e22717 VL - 7 IS - 1 KW - COVID-19 KW - diet KW - nutrition KW - obesity KW - marginalized two-part model KW - semicontinuous data N2 - Background: Nutrition is not a treatment for COVID-19, but it is a modifiable contributor to the development of chronic disease, which is highly associated with COVID-19 severe illness and deaths. A well-balanced diet and healthy patterns of eating strengthen the immune system, improve immunometabolism, and reduce the risk of chronic disease and infectious diseases. Objective: This study aims to assess the effect of diet, nutrition, obesity, and their implications for COVID-19 mortality among 188 countries by using new statistical marginalized two-part models. Methods: We globally evaluated the distribution of diet and nutrition at the national level while considering the variations between different World Health Organization regions. The effects of food supply categories and obesity on (as well as associations with) the number of deaths and the number of recoveries were reported globally by estimating coefficients and conducting color maps. Results: The findings show that a 1% increase in supplementation of pulses reduced the odds of having a zero death by 4-fold (OR 4.12, 95% CI 11.97-1.42). In addition, a 1% increase in supplementation of animal products and meat increased the odds of having a zero death by 1.076-fold (OR 1.076, 95% CI 1.01-1.15) and 1.13-fold (OR 1.13, 95% CI 1.0-1.28), respectively. Tree nuts reduced the odds of having a zero death, and vegetables increased the number of deaths. Globally, the results also showed that populations (countries) who consume more eggs, cereals excluding beer, spices, and stimulants had the greatest impact on the recovery of patients with COVID-19. In addition, populations that consume more meat, vegetal products, sugar and sweeteners, sugar crops, animal fats, and animal products were associated with more death and less recoveries in patients. The effect of consuming sugar products on mortality was considerable, and obesity has affected increased death rates and reduced recovery rates. Conclusions: Although there are differences in dietary patterns, overall, unbalanced diets are a health threat across the world and not only affect death rates but also the quality of life. To achieve the best results in preventing nutrition-related pandemic diseases, strategies and policies should fully recognize the essential role of both diet and obesity in determining good nutrition and optimal health. Policies and programs must address the need for change at the individual level and make modifications in society and the environment to make healthier choices accessible and preferable. UR - http://publichealth.jmir.org/2021/1/e22717/ UR - http://dx.doi.org/10.2196/22717 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439850 ID - info:doi/10.2196/22717 ER - TY - JOUR AU - Balestrin, Mariana AU - Brasil, Bauermann Carla Cristina AU - Bellei, Andrei Ericles AU - Kirsten, Ramos Vanessa AU - Wagner, Bernardes Mario PY - 2021/1/19 TI - Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial JO - JMIR Res Protoc SP - e22680 VL - 10 IS - 1 KW - school health services KW - healthy diet KW - pediatric obesity KW - schools KW - snacks N2 - Background: School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective: We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods: We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95% CI. Results: This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions: To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration: Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID): DERR1-10.2196/22680 UR - http://www.researchprotocols.org/2021/1/e22680/ UR - http://dx.doi.org/10.2196/22680 UR - http://www.ncbi.nlm.nih.gov/pubmed/33464219 ID - info:doi/10.2196/22680 ER - TY - JOUR AU - Bennett, G. Gary AU - Steinberg, Dori AU - Bolton, Jamiyla AU - Gallis, A. John AU - Treadway, Cayla AU - Askew, Sandy AU - Kay, C. Melissa AU - Pollak, I. Kathryn AU - Turner, L. Elizabeth PY - 2021/1/18 TI - Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial JO - JMIR Res Protoc SP - e19506 VL - 10 IS - 1 KW - text message KW - digital health KW - weight loss KW - personalized N2 - Background: Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective: The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods: We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results: The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions: Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration: ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID): RR1-10.2196/19506 UR - http://www.researchprotocols.org/2021/1/e19506/ UR - http://dx.doi.org/10.2196/19506 UR - http://www.ncbi.nlm.nih.gov/pubmed/33459600 ID - info:doi/10.2196/19506 ER - TY - JOUR AU - Tan, Ling Shu AU - Jetzke, Malte AU - Vergeld, Vera AU - Müller, Carsten PY - 2020/11/11 TI - Independent and Combined Associations of Physical Activity, Sedentary Time, and Activity Intensities With Perceived Stress Among University Students: Internet-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e20119 VL - 6 IS - 4 KW - physical activity KW - sedentary time KW - intensity of physical activity KW - perceived stress KW - university students KW - internet-based cross-sectional study KW - independent associations KW - combined associations N2 - Background: Mental health is an emerging topic on university campuses, with students reporting higher levels of psychological distress than the general population of the same age. Increasing physical activity and reducing sedentary time have been proved promising measures to promote mental health in the general population. However, to derive and implement effective measures to promote mental health among university students, further exploration of the associations between physical activity, sedentary time, and perceived stress in this specific setting is needed. Objective: This study aims to identify associations between physical activity, sedentary time, and perceived stress after controlling for sociodemographic and behavioral variables among university students in Germany. We hypothesize that perceived stress is inversely related to physical activity and positively associated with sedentary time. Furthermore, we hypothesize that combined associations of concurrently high physical activity and low sedentary time on perceived stress are stronger compared with either alone and that the association between physical activity and perceived stress depends on activity intensity. Methods: We conducted cross-sectional analyses from a large-scale internet-based student health survey (n=4189; response rate=10.0%). Physical activity, sedentary time, and engaging in moderate and vigorous activity intensities were assessed using the International Physical Activity Questionnaire Short Form with categorization into low, intermediate, and high levels. We measured perceived stress using the 10-item Perceived Stress Scale (range 0-40). Results: The results indicate that higher physical activity and lower sedentary time are associated with reduced levels of perceived stress. Following adjustment for gender, BMI, income, fruit and vegetable intake, alcohol consumption, and sleep quality, perceived stress scores were lower for students reporting high physical activity levels and low sedentary time compared with the least active and highly sedentary students (Perceived Stress Scale ?2.2, 95% CI ?2.9 to ?1.5, P<.001 for physical activity and ?1.1, CI 95% ?1.7 to ?0.5, P<.001 for sedentary time). Combined associations with perceived stress revealed that students concurrently reporting high total physical activity and low sedentary time reported the lowest perceived stress scores of all possible combinations following adjustment for confounders (Perceived Stress Scale ?3.5, CI 95% ?4.6 to ?2.5, P<.001 compared with students reporting low physical activity levels and concurrently high sedentary time). Associations between vigorous physical activities and perceived stress were not stronger compared with moderate activity intensities. Conclusions: Self-reported physical activity and low sedentary time are favorably associated with perceived stress, while the intensity of physical activities seems to be of minor importance. These results help to effectively implement health-promoting measures on campus among university students through increasing physical activity and reducing sedentary time. UR - http://publichealth.jmir.org/2020/4/e20119/ UR - http://dx.doi.org/10.2196/20119 UR - http://www.ncbi.nlm.nih.gov/pubmed/33174855 ID - info:doi/10.2196/20119 ER - TY - JOUR AU - Lutfeali, Samina AU - Ward, Tisheya AU - Greene, Tenay AU - Arshonsky, Josh AU - Seixas, Azizi AU - Dalton, Madeline AU - Bragg, A. Marie PY - 2020/10/27 TI - Understanding the Extent of Adolescents? Willingness to Engage With Food and Beverage Companies? Instagram Accounts: Experimental Survey Study JO - JMIR Public Health Surveill SP - e20336 VL - 6 IS - 4 KW - social media KW - Instagram KW - social media marketing KW - food industry KW - adolescents KW - adolescent health N2 - Background: Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents? online relationships with unhealthy food brands. Objective: We aimed to understand the extent to which adolescents? preferences for Instagram food ads are shaped by the presence of comments and varying numbers of ?likes.? We hypothesized that adolescents would show the highest preferences for ads with more ?likes? and comments. We predicted that these differences would be greater among adolescents who were ?heavy social media users? (ie, >3 hours daily) vs ?light social media users? (ie, <3 hours daily). Methods: We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of ?likes.? Adolescents reported ad preferences and willingness to engage with the brand. Results: Adolescents rated ads with medium or high numbers of ?likes? higher than ads with few ?likes? (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001). Conclusions: Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many ?likes,? demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children?s Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years. UR - https://publichealth.jmir.org/2020/4/e20336 UR - http://dx.doi.org/10.2196/20336 UR - http://www.ncbi.nlm.nih.gov/pubmed/33107836 ID - info:doi/10.2196/20336 ER - TY - JOUR AU - Hu, A. Emily AU - Nguyen, Viet AU - Langheier, Jason AU - Shurney, Dexter PY - 2020/9/2 TI - Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study JO - J Med Internet Res SP - e19634 VL - 22 IS - 9 KW - digital KW - nutrition KW - meal planning KW - weight loss KW - obese KW - food environment KW - food ordering KW - food purchasing KW - behavioral economics KW - behavior change KW - eating behavior KW - mHealth KW - app N2 - Background: Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. Objective: The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. Methods: We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. Results: Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss. Conclusions: This study found that a digital app that provides personalized nutrition recommendations and change in one?s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity. UR - http://www.jmir.org/2020/9/e19634/ UR - http://dx.doi.org/10.2196/19634 UR - http://www.ncbi.nlm.nih.gov/pubmed/32792332 ID - info:doi/10.2196/19634 ER - TY - JOUR AU - Pawar, S. Aditya AU - Nagpal, Sajan AU - Pawar, Neha AU - Lerman, O. Lilach AU - Eirin, Alfonso PY - 2020/8/11 TI - General Public?s Information-Seeking Patterns of Topics Related to Obesity: Google Trends Analysis JO - JMIR Public Health Surveill SP - e20923 VL - 6 IS - 3 KW - obesity KW - normalization KW - public awareness KW - infodemiology KW - infoveillance N2 - Background: Obesity is a major public health challenge, and recent literature sheds light on the concept of ?normalization? of obesity. Objective: We aimed to study the worldwide pattern of web-based information seeking by public on obesity and on its related terms and topics using Google Trends. Methods: We compared the relative frequency of obesity-related search terms and topics between 2004 and 2019 on Google Trends. The mean relative interest scores for these terms over the 4-year quartiles were compared. Results: The mean relative interest score of the search term ?obesity? consistently decreased with time in all four quartiles (2004-2019), whereas the relative interest scores of the search topics ?weight loss? and ?abdominal obesity? increased. The topic ?weight loss? was popular during the month of January, and its median relative interest score for January was higher than that for other months for the entire study period (P<.001). The relative interest score for the search term ?obese? decreased over time, whereas those scores for the terms ?body positivity? and ?self-love? increased after 2013. Conclusions: Despite a worldwide increase in the prevalence of obesity, its popularity as an internet search term diminished over time. The reason for peaks in months should be explored and applied to the awareness campaigns for better effectiveness. These patterns suggest normalization of obesity in society and a rise of public curiosity about image-related obesity rather than its medical implications and harm. UR - http://publichealth.jmir.org/2020/3/e20923/ UR - http://dx.doi.org/10.2196/20923 UR - http://www.ncbi.nlm.nih.gov/pubmed/32633725 ID - info:doi/10.2196/20923 ER - TY - JOUR AU - Hammons, Jean Amber AU - Villegas, Elizabeth AU - Olvera, Norma AU - Greder, Kimberly AU - Fiese, Barbara AU - Teran-Garcia, Margarita AU - PY - 2020/8/10 TI - The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers JO - JMIR Pediatr Parent SP - e18292 VL - 3 IS - 2 KW - family mealtimes KW - healthy eating KW - technology at the table KW - parenting and mealtimes KW - Hispanic culture KW - obesity prevention N2 - Background: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. Objective: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. Methods: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. Results: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. Conclusions: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone?s tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives. UR - http://pediatrics.jmir.org/2020/2/e18292/ UR - http://dx.doi.org/10.2196/18292 UR - http://www.ncbi.nlm.nih.gov/pubmed/32576547 ID - info:doi/10.2196/18292 ER - TY - JOUR AU - Brigden, Amberly AU - Anderson, Emma AU - Linney, Catherine AU - Morris, Richard AU - Parslow, Roxanne AU - Serafimova, Teona AU - Smith, Lucie AU - Briggs, Emily AU - Loades, Maria AU - Crawley, Esther PY - 2020/7/31 TI - Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review JO - J Med Internet Res SP - e16924 VL - 22 IS - 7 KW - mobile phone KW - mHealth KW - mobile health KW - eHealth KW - electronic health KW - digital health KW - behavior KW - pediatrics KW - chronic illness KW - systematic review N2 - Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user?s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user?s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. UR - http://www.jmir.org/2020/7/e16924/ UR - http://dx.doi.org/10.2196/16924 UR - http://www.ncbi.nlm.nih.gov/pubmed/32735227 ID - info:doi/10.2196/16924 ER - TY - JOUR AU - Spanhol-Finocchio, Caroline AU - de Freitas Dewes, Mariana AU - de Vargas Mores, Giana AU - Dewes, Homero PY - 2020/7/29 TI - Text Mining of United States Obesity-Related Public Policies: Systematic Document Search JO - JMIR Public Health Surveill SP - e13235 VL - 6 IS - 3 KW - government KW - data mining KW - school KW - health policy N2 - Background: Obesity has become a worldwide health problem, caused by multiple and complex factors. To face this challenge, governments have played a central role in combating its rise. Considering this, public policies are introduced or enacted for the benefit of whole populations, taking into account the perspective of multiverse social stakeholders based on solid scientific fundamentals. Objective: The aim of this study was to examine obesity-related public policies in the United States and the District of Columbia, in order to understand their scientific basis. Methods: We analyzed the public policies implemented in the United States from 2003 to 2013, during which time the largest number of obesity-related public policies were introduced, using text mining. Results: In total, 1592 obesity-related public policies were retrieved from the Centers for Disease Control and Prevention. Multidisciplinary policies were predominant in the documents analyzed (533/1592, 33.5%), followed by health sciences (454/1592, 28.5%), social sciences (330/1592, 20.7%), life sciences (240/1592, 15.1%), and physical sciences (35/1592, 2.2%). Throughout the country, most policies were community oriented (1082/1865, 58.0%) and many of them were related to school and family environments (447/1865, 24.0%), early care and education (75/1865, 4.0%), hospitals (63/1865, 3.4%), and workplaces (47/1865, 2.5%). Conclusions: The contents of obesity-related public policies were generally uniformly framed across the United States. They were generally based on scientific references, in which there was a predominance of multidisciplinary research. These findings are consistent with what is known about the multiple factors causing obesity and about the methods being developed to control the epidemic. UR - http://publichealth.jmir.org/2020/3/e13235/ UR - http://dx.doi.org/10.2196/13235 UR - http://www.ncbi.nlm.nih.gov/pubmed/32723715 ID - info:doi/10.2196/13235 ER - TY - JOUR AU - Chhabria, Karishma AU - Ross, M. Kathryn AU - Sacco, J. Shane AU - Leahey, M. Tricia PY - 2020/7/28 TI - The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study JO - J Med Internet Res SP - e17967 VL - 22 IS - 7 KW - supportive accountability KW - social support KW - SALLIS KW - factor analysis KW - obesity KW - weight loss KW - technology KW - mobile phone N2 - Background: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. Objective: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. Methods: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. Results: In Study 1 (n=353), the SAM showed strong reliability (Cronbach ?=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=?0.26; P=.06). Conclusions: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. Trial Registration: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244 UR - https://www.jmir.org/2020/7/e17967 UR - http://dx.doi.org/10.2196/17967 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720911 ID - info:doi/10.2196/17967 ER - TY - JOUR AU - Hawley, L. Nicola AU - Pomer, Alysa AU - Rivara, C. Anna AU - Rosenthal, L. Samantha AU - Duckham, L. Rachel AU - Carlson, C. Jenna AU - Naseri, Take AU - Reupena, Sefuiva Muagututia AU - Selu, Melania AU - Lupematisila, Vaimoana AU - Unasa, Folla AU - Vesi, Lupesina AU - Fatu, Tracy AU - Unasa, Seipepa AU - Faasalele-Savusa, Kima AU - Wetzel, I. Abigail AU - Soti-Ulberg, Christina AU - Prescott, T. Angela AU - Siufaga, Gloria AU - Penaia, Corina AU - To, B. Sophie AU - LaMonica, C. Lauren AU - Lameko, Viali AU - Choy, C. Courtney AU - Crouter, E. Scott AU - Redline, Susan AU - Deka, Ranjan AU - Kershaw, E. Erin AU - Urban, Zsolt AU - Minster, L. Ryan AU - Weeks, E. Daniel AU - McGarvey, T. Stephen PY - 2020/7/23 TI - Exploring the Paradoxical Relationship of a Creb 3 Regulatory Factor Missense Variant With Body Mass Index and Diabetes Among Samoans: Protocol for the Soifua Manuia (Good Health) Observational Cohort Study JO - JMIR Res Protoc SP - e17329 VL - 9 IS - 7 KW - cohort studies KW - CREBRF KW - type 2 diabetes KW - obesity KW - Samoa N2 - Background: The prevalence of obesity and diabetes in Samoa, like many other Pacific Island nations, has reached epidemic proportions. Although the etiology of these conditions can be largely attributed to the rapidly changing economic and nutritional environment, a recently identified genetic variant, rs373863828 (CREB 3 regulatory factor, CREBRF: c.1370G>A p.[R457Q]) is associated with increased odds of obesity, but paradoxically, decreased odds of diabetes. Objective: The overarching goal of the Soifua Manuia (Good Health) study was to precisely characterize the association of the CREBRF variant with metabolic (body composition and glucose homeostasis) and behavioral traits (dietary intake, physical activity, sleep, and weight control behaviors) that influence energy homeostasis in 500 adults. Methods: A cohort of adult Samoans who participated in a genome-wide association study of adiposity in Samoa in 2010 was followed up, based on the presence or absence of the CREBRF variant, between August 2017 and March 2019. Over a period of 7-10 days, each participant completed the main study protocol, which consisted of anthropometric measurements (weight, height, circumferences, and skinfolds), body composition assessment (bioelectrical impedance and dual-energy x-ray absorptiometry), point-of-care glycated hemoglobin measurement, a fasting blood draw and oral glucose tolerance test, urine collection, blood pressure measurement, hand grip strength measurement, objective physical activity and sleep apnea monitoring, and questionnaire measures (eg, health interview, cigarette and alcohol use, food frequency questionnaire, socioeconomic position, stress, social support, food and water insecurity, sleep, body image, and dietary preferences). In January 2019, a subsample of the study participants (n=118) completed a buttock fat biopsy procedure to collect subcutaneous adipose tissue samples. Results: Enrollment of 519 participants was completed in March 2019. Data analyses are ongoing, with results expected in 2020 and 2021. Conclusions: While the genetic variant rs373863828, in CREBRF, has the largest known effect size of any identified common obesity gene, very little is currently understood about the mechanisms by which it confers increased odds of obesity but paradoxically lowered odds of type 2 diabetes. The results of this study will provide insights into how the gene functions on a whole-body level, which could provide novel targets to prevent or treat obesity, diabetes, and associated metabolic disorders. This study represents the human arm of a comprehensive and integrated approach involving humans as well as preclinical models that will provide novel insights into metabolic disease. International Registered Report Identifier (IRRID): RR1-10.2196/17329 UR - https://www.researchprotocols.org/2020/7/e17329 UR - http://dx.doi.org/10.2196/17329 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706746 ID - info:doi/10.2196/17329 ER - TY - JOUR AU - McMahon, Joy Emma AU - Jaenke, Rachael AU - Brimblecombe, Julie PY - 2020/7/22 TI - A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study JO - JMIR Mhealth Uhealth SP - e16971 VL - 8 IS - 7 KW - mobile apps KW - reliability and validity KW - food KW - diet KW - environment and public health N2 - Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8%) or good (n=81/196, 41.3%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. UR - https://mhealth.jmir.org/2020/7/e16971 UR - http://dx.doi.org/10.2196/16971 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706683 ID - info:doi/10.2196/16971 ER - TY - JOUR AU - LeRouge, M. Cynthia AU - Hah, Hyeyoung AU - Deckard, J. Gloria AU - Jiang, Haoqiang PY - 2020/6/29 TI - Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study JO - JMIR Mhealth Uhealth SP - e18391 VL - 8 IS - 6 KW - consumer health technologies KW - obesity care model KW - chronic care model KW - UTAUT KW - qualitative research KW - overweight KW - mobile phone KW - adolescent KW - couse KW - social support KW - obesity KW - social influence KW - consumer health informatics N2 - Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents? intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. UR - http://mhealth.jmir.org/2020/6/e18391/ UR - http://dx.doi.org/10.2196/18391 UR - http://www.ncbi.nlm.nih.gov/pubmed/32597788 ID - info:doi/10.2196/18391 ER - TY - JOUR AU - Brandt, J. Carl AU - Christensen, Reffstrup Jeanette AU - Lauridsen, T. Jørgen AU - Nielsen, Bo Jesper AU - Søndergaard, Jens AU - Sortsø, Camilla PY - 2020/6/25 TI - Evaluation of the Clinical and Economic Effects of a Primary Care Anchored, Collaborative, Electronic Health Lifestyle Coaching Program in Denmark: Protocol for a Two-Year Randomized Controlled Trial JO - JMIR Res Protoc SP - e19172 VL - 9 IS - 6 KW - type 2 diabetes management KW - digital behavioral coaching KW - lifestyle change KW - health behavior change KW - obesity KW - weight loss KW - interactive advice KW - participant engagement KW - quality of life N2 - Background: Obesity is linked to a number of chronic health conditions, such as type 2 diabetes, heart disease, and cancer, and weight loss interventions are often expensive. Recent systematic reviews concluded that app and web-based interventions can improve lifestyle behaviors and weight loss at a reasonable cost, but long-term sustainability needs to be demonstrated. Objective: This study protocol is for a 2-year randomized controlled trial that aims to evaluate the clinical and economic effects of a primary care, anchored, collaborative, electronic health (eHealth) lifestyle coaching program (long-term Lifestyle change InterVention and eHealth Application [LIVA] 2.0) in obese participants with and without type 2 diabetes. The program?s primary outcome is weight loss. Its secondary outcome is the hemoglobin A1c (HbA1c) level, and its tertiary outcomes are retention rate, quality of life (QOL), and cost effectiveness. Analytically, the focus is on associations of participant characteristics with outcomes and sustainability. Methods: We conduct a multicenter trial with a 1-year intervention and 1-year retention. LIVA 2.0 is implemented in municipalities within administrative regions in Denmark, specifically eight municipalities located within the Region of Southern Denmark and two municipalities located within the Capital Region of Denmark. The participants are assessed at baseline and at 6-, 12-, and 24-month follow-ups. Individual data from the LIVA 2.0 platform are combined with clinical measurements, questionnaires, and participants? usage of municipality and health care services. The participants have a BMI ?30 but ?45 kg/m2, and 50% of the participants have type 2 diabetes. The participants are randomized in an approximately 60:40 manner, and based on sample size calculations on weight loss and intention-to-treat statistics, 200 participants are randomized to an intervention group and 140 are randomized to a control group. The control group is offered the conventional preventive program of the municipality, and it is compared to the intervention group, which follows the LIVA 2.0 in addition to the conventional preventive program. Results: The first baseline assessments have been carried out in March 2018, and the 2-year follow-up will be carried out between March 2020 and April 2021. The hypothesis is that the trial results will demonstrate decreased body weight and that the number of patients who show normalization of their HbA1c levels in the intervention group will be much higher than that in the control group. The participants in the intervention group are also expected to show a greater decrease in their use of glucose-lowering medication and a greater improvement in their QOL when compared with the control group. Operational costs are expected to be lower than standard care, and the intervention is expected to be cost-effective. Conclusions: This is the first time that an app and web-based eHealth lifestyle coaching program implemented in Danish municipalities will be clinically and economically evaluated. If the LIVA 2.0 eHealth lifestyle coaching program is proven to be effective, there is great potential for decreasing the rates of obesity, diabetes, and related chronic diseases. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 International Registered Report Identifier (IRRID): DERR1-10.2196/19172 UR - http://www.researchprotocols.org/2020/6/e19172/ UR - http://dx.doi.org/10.2196/19172 UR - http://www.ncbi.nlm.nih.gov/pubmed/32584260 ID - info:doi/10.2196/19172 ER - TY - JOUR AU - Hsu, Wan-Chen AU - Chiang, Chia-Hsun PY - 2020/6/11 TI - Effect of BMI and Perceived Importance of Health on the Health Behavior of College Students: Cross-Sectional Study JO - J Med Internet Res SP - e17640 VL - 22 IS - 6 KW - body mass index KW - college students KW - health behavior KW - perceived importance of health N2 - Background: Both body mass index (BMI) and the perceived importance of health have received a lot of attention, but few studies have fully investigated the interaction of their effects on health behaviors. Objective: This study investigates the effects of BMI and the perceived importance of health on health behaviors (patterns of eating, sleeping, and exercising) among college students in Taiwan. Methods: A survey was conducted with 334 students to assess their perception of the importance of health (using indicators) and their health behavior (using the Health Behaviors Scale). Respondent BMI was calculated from self-reported body weight and height. Descriptive statistical analysis, independent t test analysis, two-way analysis of variance (ANOVA), and one-way ANOVA were conducted. Results: The results showed a significant difference between genders in health behaviors among college students (eating: t332=2.17, P=.03; exercise: t332=5.57, P<.001; sleep: t332=2.58, P=.01). Moreover, there was an interaction between BMI and perception (of the importance of health) for exercise behaviors (F2,328=3.50, P=.03), but not for eating behaviors (F2,328=0.12, P=.89) or sleep behaviors (F2,328=1.64, P=.20). Conclusions: This study establishes, for the first time, the interaction of BMI and the perceived importance of health on health behaviors. The perception of health was found to have a significant effect on exercise behaviors. Thus, the perception of health plays a significant role in the exercise behaviors of college students in Taiwan. This finding provides researchers, policy makers, and practitioners with evidence, and consequently, opportunities for focusing on preventive actions. The findings suggest that increasing the importance of health in the perception of college students, should be the focus of efforts to help students exercise more regularly. UR - https://www.jmir.org/2020/6/e17640 UR - http://dx.doi.org/10.2196/17640 UR - http://www.ncbi.nlm.nih.gov/pubmed/32525487 ID - info:doi/10.2196/17640 ER - TY - JOUR AU - Giorgi Rossi, Paolo AU - Ferrari, Francesca AU - Amarri, Sergio AU - Bassi, Andrea AU - Bonvicini, Laura AU - Dall'Aglio, Luca AU - Della Giustina, Claudia AU - Fabbri, Alessandra AU - Ferrari, Maria Anna AU - Ferrari, Elena AU - Fontana, Marta AU - Foracchia, Marco AU - Gallelli, Teresa AU - Ganugi, Giulia AU - Ilari, Barbara AU - Lo Scocco, Sara AU - Maestri, Gianluca AU - Moretti, Veronica AU - Panza, Costantino AU - Pinotti, Mirco AU - Prandini, Riccardo AU - Storani, Simone AU - Street, Elisabeth Maria AU - Tamelli, Marco AU - Trowbridge, Hayley AU - Venturelli, Francesco AU - Volta, Alessandro AU - Davoli, Maria Anna AU - PY - 2020/6/8 TI - Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study JO - JMIR Mhealth Uhealth SP - e16165 VL - 8 IS - 6 KW - childhood obesity KW - health promotion KW - mHealth KW - cocreation KW - mobile app N2 - Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents? phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children?s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. UR - https://mhealth.jmir.org/2020/6/e16165 UR - http://dx.doi.org/10.2196/16165 UR - http://www.ncbi.nlm.nih.gov/pubmed/32357123 ID - info:doi/10.2196/16165 ER - TY - JOUR AU - Darvall, N. Jai AU - Wang, Andrew AU - Nazeem, Nusry Mohamed AU - Harrison, L. Cheryce AU - Clarke, Lauren AU - Mendoza, Chennelle AU - Parker, Anna AU - Harrap, Benjamin AU - Teale, Glyn AU - Story, David AU - Hessian, Elizabeth PY - 2020/5/26 TI - A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study JO - JMIR Mhealth Uhealth SP - e15112 VL - 8 IS - 5 KW - gestational weight gain KW - pregnancy KW - maternal obesity KW - lifestyle intervention KW - pedometer N2 - Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to both mother and child. A major contributor to both prepregnancy obesity and excessive GWG is physical inactivity; however, past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution for increasing activity levels in this population. Objective: This initial feasibility randomized controlled trial aimed to test a pedometer-based intervention to increase activity and reduce excessive GWG in pregnant women. Methods: We supplied 30 pregnant women with obesity a Fitbit Zip pedometer and randomized them into 1 of 3 groups: control (pedometer only), app (pedometer synced to patients? personal smartphone, with self-monitoring of activity), or app-coach (addition of a health coach?delivered behavioral change program). Feasibility outcomes included participant compliance with wearing pedometers (days with missing pedometer data), data syncing, and data integrity. Activity outcomes (step counts and active minutes) were analyzed using linear mixed models and generalized estimating equations. Results: A total of 30 participants were recruited within a 10-week period, with a dropout rate of 10% (3/30; 2 withdrawals and 1 stillbirth); 27 participants thus completed the study. Mean BMI in all groups was ?35 kg/m2. Mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, app group, and app-coach group patients, respectively. Estimated mean baseline activity levels were 14.5 active min/day and 5455 steps/day, with no significant differences found in activity levels between groups, with mean daily step counts in all groups remaining in the sedentary (5000 steps/day) or low activity (5000-7499 steps/day) categories for the entire study duration. There was a mean decrease of 7.8 steps/day for each increase in gestation day over the study period (95% CI 2.91 to 12.69, P=.002). Conclusions: Activity data syncing with a personal smartphone is feasible in a cohort of pregnant women with obesity. However, our results do not support a future definitive study in its present form. Recruitment and retention rates were adequate, as was activity data syncing to participants? smartphones. A follow-up interventional trial seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording and behavioral interventions delivered. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12617000038392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370884 UR - http://mhealth.jmir.org/2020/5/e15112/ UR - http://dx.doi.org/10.2196/15112 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348280 ID - info:doi/10.2196/15112 ER - TY - JOUR AU - Martin, Anne AU - Caon, Maurizio AU - Adorni, Fulvio AU - Andreoni, Giuseppe AU - Ascolese, Antonio AU - Atkinson, Sarah AU - Bul, Kim AU - Carrion, Carme AU - Castell, Conxa AU - Ciociola, Valentina AU - Condon, Laura AU - Espallargues, Mireia AU - Hanley, Janet AU - Jesuthasan, Nithiya AU - Lafortuna, L. Claudio AU - Lang, Alexandra AU - Prinelli, Federica AU - Puidomenech Puig, Elisa AU - Tabozzi, A. Sarah AU - McKinstry, Brian PY - 2020/3/2 TI - A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study JO - JMIR Mhealth Uhealth SP - e14118 VL - 8 IS - 3 KW - health behavior KW - obesity KW - co-design KW - mHealth KW - mobile app KW - mobile phone KW - adolescents KW - youth KW - focus groups N2 - Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight?promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants? user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents? preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. UR - https://mhealth.jmir.org/2020/3/e14118 UR - http://dx.doi.org/10.2196/14118 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130179 ID - info:doi/10.2196/14118 ER - TY - JOUR AU - Colby, Sarah AU - Moret, Lauren AU - Olfert, D. Melissa AU - Kattelmann, Kendra AU - Franzen-Castle, Lisa AU - Riggsbee, Kristin AU - Payne, Magen AU - Ellington, Ainsley AU - Springer, Cary AU - Allison, Chelsea AU - Wiggins, Sa'Nealdra AU - Butler, Rochelle AU - Mathews, Douglas AU - White, A. Adrienne PY - 2019/08/29 TI - Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial JO - JMIR Pediatr Parent SP - e11235 VL - 2 IS - 2 KW - technology KW - videos KW - intervention KW - cooking KW - child health N2 - Background: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. Objective: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. Methods: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. Results: Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. Conclusions: Incorporating technological supports, such as cameras and websites, into children?s programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. Trial Registration: ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351 UR - http://pediatrics.jmir.org/2019/2/e11235/ UR - http://dx.doi.org/10.2196/11235 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518323 ID - info:doi/10.2196/11235 ER - TY - JOUR AU - Li, Yuan AU - Ding, Jingmin AU - Wang, Yishan AU - Tang, Chengyao AU - Zhang, Puhong PY - 2019/07/30 TI - Nutrition-Related Mobile Apps in the China App Store: Assessment of Functionality and Quality JO - JMIR Mhealth Uhealth SP - e13261 VL - 7 IS - 7 KW - mobile phone KW - mobile apps KW - apps KW - nutrition KW - diet KW - food KW - behavior change N2 - Background: There are an increasing number of mobile apps that provide dietary guidance to support a healthy lifestyle and disease management. However, the characteristics of these nutrition-related apps are not well analyzed. Objective: This study aimed to evaluate the functionality and quality of nutrition-related apps in China. Methods: Mobile apps providing dietary guidance were screened in the Chinese iOS and Android app stores in November 2017, using stepwise searching criteria. The first screening consisted of extracting information from the app descriptions. Apps that (1) were free, (2) contain information on diet and nutrition, and (3) were last updated after January 1, 2016, were downloaded for further analysis. Nutritional functionalities were determined according to the Chinese Dietary Guidelines framework. Market-related functionalities were developed from previous studies and tailored to downloaded apps. The quality of apps was assessed with the user version of the Mobile App Rating Scale (uMARS). Results: Out of 628 dietary guidance apps screened, 44 were nutrition-related. Of these, guidance was provided on diet exclusively (11/44, 25%), fitness (17/44, 39%), disease management (11/44, 25%), or maternal health (5/44, 11%). Nutritional functionalities included nutritional information inquiry (40/44, 91%), nutrition education (35/44, 80%), food record (34/44, 77%), diet analysis (34/44, 77%), and personalized recipes (21/44, 48%). Dietary analysis and suggestions mainly focused on energy intake (33/44, 75%) and less on other factors such as dietary structure (10/44, 23%). Social communication functionalities were available in 42 apps (96%), user incentives were supported in 26 apps (59%), and intelligent recognition technology was available in 8 apps (18%). The median score for the quality of the 44 apps, as determined on a 5-point uMARS scale, was 3.6 (interquartile range 0.7). Conclusions: Most nutrition-related apps are developed for health management rather than for dietary guidance exclusively. Although basic principles of energy balance are used, their nutritional functionality was relatively limited and not individualized. More efforts should be made to develop nutrition-related apps with evidence-based nutritional knowledge, comprehensive and personalized dietary guidance, and innovative technology. UR - http://mhealth.jmir.org/2019/7/e13261/ UR - http://dx.doi.org/10.2196/13261 UR - http://www.ncbi.nlm.nih.gov/pubmed/31364606 ID - info:doi/10.2196/13261 ER - TY - JOUR AU - Jiang, Hong AU - Li, Mu AU - Wen, Ming Li AU - Baur, Louise AU - He, Gengsheng AU - Ma, Xiaoying AU - Qian, Xu PY - 2019/6/3 TI - A Community-Based Short Message Service Intervention to Improve Mothers? Feeding Practices for Obesity Prevention: Quasi-Experimental Study JO - JMIR Mhealth Uhealth SP - e13828 VL - 7 IS - 6 KW - short message service KW - child development KW - body mass index KW - BMI KW - childhood obesity N2 - Background: The prevalence of childhood obesity is increasing in China, and the effect of mobile phone short message service (SMS) interventions to prevent early childhood obesity needs to be evaluated. Objective: The objective of this study was to assess the effect of an SMS intervention on the prevention of obesity in young children. Methods: A quasi-experimental design SMS intervention was carried out in 4 community health centers (CHCs) in Shanghai, China. A total of 2 CHCs were assigned to the intervention group, and 2 CHCs were assigned to the control group. Mothers in the intervention group received weekly SMS messages on breastfeeding and infant feeding from the third trimester to 12 months postpartum. The primary outcomes were children?s body mass index (BMI), BMI z-score, and weight-for-length z-score at 12 and 24 months. Factors associated with higher BMI and weight-for-length z-score at 24 months were also assessed. Results: A total of 582 expectant mothers were recruited at the beginning of the third gestational trimester. 477 (82.0%) and 467 (80.2%) mothers and their children were followed up to 12 and 24 months postpartum, respectively. There were no significant differences in children?s BMI, BMI z-score, and weight-for-length z-score at 12 and 24 months between the 2 groups. Factors associated with higher BMI, BMI z-score, and weight-for-length z-score at 24 months included higher birth weight, introduction of solid foods before 4 months, and taking a bottle to bed at 12 months. Conclusions: The SMS intervention did not show a significant effect on children?s BMI, BMI z-score, or weight-for-length z-score at 12 and 24 months. Introduction of solid foods before 4 months and taking a bottle to bed at 12 months were significantly and positively correlated with a higher BMI, BMI z-score, and weight-for-length z-score at 24 months. Further studies with more rigorous design are needed to evaluate the effect of SMS interventions on preventing early childhood obesity. UR - http://mhealth.jmir.org/2019/6/e13828/ UR - http://dx.doi.org/10.2196/13828 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13828 ER - TY - JOUR AU - Chan, Renee AU - Nguyen, Matthew AU - Smith, Rachel AU - Spencer, Sarah AU - Pit, Winona Sabrina PY - 2019/04/24 TI - Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e11832 VL - 7 IS - 4 KW - text messages KW - obesity KW - waist-hip ratio KW - weight reduction programs KW - mHealth N2 - Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. Methods: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. Results: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61%) and the least in week 8 (8/23, 35%). No harm was found to result from this study. Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw) UR - https://mhealth.jmir.org/2019/4/e11832/ UR - http://dx.doi.org/10.2196/11832 UR - http://www.ncbi.nlm.nih.gov/pubmed/31017585 ID - info:doi/10.2196/11832 ER - TY - JOUR AU - Kite, James AU - Grunseit, Anne AU - Li, Vincy AU - Vineburg, John AU - Berton, Nathan AU - Bauman, Adrian AU - Freeman, Becky PY - 2019/01/14 TI - Generating Engagement on the Make Healthy Normal Campaign Facebook Page: Analysis of Facebook Analytics JO - JMIR Public Health Surveill SP - e11132 VL - 5 IS - 1 KW - social media KW - Facebook KW - overweight and obesity KW - mass media campaign KW - evaluation N2 - Background: Facebook is increasingly being used as part of mass media campaigns in public health, including the Make Healthy Normal (MHN) campaign in New South Wales, Australia. Therefore, it is important to understand what role Facebook can play in mass media campaigns and how best to use it to augment or amplify campaign effects. However, few studies have explored this. Objective: This study aimed to investigate usage of and engagement with the MHN Facebook page and to identify influential factors in driving engagement with the page. Methods: We examined both post-level and page-level analytic data from Facebook from the campaign?s launch in June 2015 to September 2017. For post-level data, we conducted a series of negative binomial regressions with four different outcome measures (likes, shares, comments, post consumers), including some characteristics of Facebook posts as predictors. We also conducted time series analyses to examine associations between page-level outcomes (new page likes or ?fans? and number of engaged users) and different measures of exposure to the page (number of unique users reached and total count of impressions) and to television advertising. Results: Of the 392 posts reviewed, 20.7% (n=81) received a paid boost and 58.9% (n=231) were photo posts. We found that posts that received a paid boost reached significantly more users and subsequently received significantly more engagement than organic (unpaid) posts (P<.001). After adjusting for reach, we found the effect of being paid was incremental for all outcome measures for photos and links, but not videos. There were also associations between day of the week and time of post and engagement, with Mondays generally receiving less engagement and posts on a Friday and those made between 8 AM and 5 PM receiving more. At the page level, our time series analyses found that organic impressions predicted a higher number of new fans and engaged users, compared to paid impressions, especially for women. We also found no association between television advertising and engagement with the Facebook page. Conclusions: Our study shows that paying for posts is important for increasing their reach, but that page administrators should look to maximize organic reach because it is associated with significantly higher engagement. Once reach is accounted for, video posts do not benefit from being paid, unlike the other post types. This suggests that page administrators should carefully consider how they use videos as part of a Facebook campaign. Additionally, the lack of association between television advertising and engagement suggests that future campaigns consider how best to link different channels to amplify effects. These results highlight the need for ongoing evaluation of Facebook pages if administrators are to maximize engagement. UR - https://publichealth.jmir.org/2019/1/e11132/ UR - http://dx.doi.org/10.2196/11132 UR - http://www.ncbi.nlm.nih.gov/pubmed/31344679 ID - info:doi/10.2196/11132 ER - TY - JOUR AU - Schembre, M. Susan AU - Liao, Yue AU - O'Connor, G. Sydney AU - Hingle, D. Melanie AU - Shen, Shu-En AU - Hamoy, G. Katarina AU - Huh, Jimi AU - Dunton, F. Genevieve AU - Weiss, Rick AU - Thomson, A. Cynthia AU - Boushey, J. Carol PY - 2018/11/20 TI - Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review JO - JMIR Mhealth Uhealth SP - e11170 VL - 6 IS - 11 KW - diet surveys KW - diet records KW - mobile phone KW - mobile apps KW - ecological momentary assessment N2 - Background: New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device?assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings. Objective: The aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research. Methods: Studies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively. Results: The review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods. Conclusions: This review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity. UR - http://mhealth.jmir.org/2018/11/e11170/ UR - http://dx.doi.org/10.2196/11170 UR - http://www.ncbi.nlm.nih.gov/pubmed/30459148 ID - info:doi/10.2196/11170 ER - TY - JOUR AU - Zhou, Jun AU - Bell, Dane AU - Nusrat, Sabrina AU - Hingle, Melanie AU - Surdeanu, Mihai AU - Kobourov, Stephen PY - 2018/11/05 TI - Calorie Estimation From Pictures of Food: Crowdsourcing Study JO - Interact J Med Res SP - e17 VL - 7 IS - 2 KW - calorie estimation KW - image annotation KW - crowdsourcing KW - obesity KW - public health N2 - Background: Software designed to accurately estimate food calories from still images could help users and health professionals identify dietary patterns and food choices associated with health and health risks more effectively. However, calorie estimation from images is difficult, and no publicly available software can do so accurately while minimizing the burden associated with data collection and analysis. Objective: The aim of this study was to determine the accuracy of crowdsourced annotations of calorie content in food images and to identify and quantify sources of bias and noise as a function of respondent characteristics and food qualities (eg, energy density). Methods: We invited adult social media users to provide calorie estimates for 20 food images (for which ground truth calorie data were known) using a custom-built webpage that administers an online quiz. The images were selected to provide a range of food types and energy density. Participants optionally provided age range, gender, and their height and weight. In addition, 5 nutrition experts provided annotations for the same data to form a basis of comparison. We examined estimated accuracy on the basis of expertise, demographic data, and food qualities using linear mixed-effects models with participant and image index as random variables. We also analyzed the advantage of aggregating nonexpert estimates. Results: A total of 2028 respondents agreed to participate in the study (males: 770/2028, 37.97%, mean body mass index: 27.5 kg/m2). Average accuracy was 5 out of 20 correct guesses, where ?correct? was defined as a number within 20% of the ground truth. Even a small crowd of 10 individuals achieved an accuracy of 7, exceeding the average individual and expert annotator?s accuracy of 5. Women were more accurate than men (P<.001), and younger people were more accurate than older people (P<.001). The calorie content of energy-dense foods was overestimated (P=.02). Participants performed worse when images contained reference objects, such as credit cards, for scale (P=.01). Conclusions: Our findings provide new information about how calories are estimated from food images, which can inform the design of related software and analyses. UR - http://www.i-jmr.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/ijmr.9359 UR - http://www.ncbi.nlm.nih.gov/pubmed/30401671 ID - info:doi/10.2196/ijmr.9359 ER - TY - JOUR AU - Showell, N. Nakiya AU - Koebnick, Corinna AU - DeCamp, R. Lisa AU - Sidell, Margo AU - Rivera Rodriguez, Tatiahna AU - Jimenez, J. Jennifer AU - Young, Deborah AU - Thornton, LJ Rachel PY - 2018/11/05 TI - Parental Activation and Obesity-Related Health Behaviors Among a Racially and Ethnically Diverse Population of Low-Income Pediatric Patients: Protocol for a Cross-Sectional Survey Study JO - JMIR Res Protoc SP - e182 VL - 7 IS - 11 KW - activation KW - parent KW - child KW - health behaviors KW - obesity KW - primary care N2 - Background: Despite a recent decline in the obesity prevalence among preschool-aged children, obesity remains disproportionately high among children from low-income racial or ethnic minority families. Promoting healthy lifestyles (eg, obesity-preventative behaviors) in primary care settings is particularly important for young children, given the frequency of preventative health visits and parent-provider interactions. Higher adoption of specific health behaviors is correlated with increased patient activation (ie, skill, confidence, and knowledge to manage their health care) among adults. However, no published study, to date, has examined the relationship between parental activation and obesity-related health behaviors among young children. Objective: The goal of this study is to measure parental activation in low-income parents of preschoolers in 2 large health systems and to examine the association with diet, screen-time, and physical activity behaviors. Methods: We will conduct a cross-sectional study of parents of preschool-aged patients (2-5 years) receiving primary care at multiple clinic sites within 2 large health care systems. Study participants, low-income black, Hispanic, and white parents of preschool-aged patients, are being recruited across both health systems to complete orally administered surveys. Results: Recruitment began in December 2017 and is expected to end in May 2018. A total of 267 low-income parents of preschool-aged children have been enrolled across both clinic sites. We are enrolling an additional 33 parents to reach our goal sample size of 300 across both health systems. The data analysis will be completed in June 2018. Conclusions: This protocol outlines the first study to fully examine parental activation and its relationship with parent-reported diet, physical activity, and screen-time behaviors among low-income preschool-aged patients. It involves recruitment across 2 geographically distinct areas and resulting from a partnership between researchers at 2 different health systems with multiple clinical sites. This study will provide new knowledge about how parental activation can potentially be incorporated as a strategy to address childhood obesity disparities in primary care settings. International Registered Report Identifier (IRRID): RR1-10.2196/9688 UR - http://www.researchprotocols.org/2018/11/e182/ UR - http://dx.doi.org/10.2196/resprot.9688 UR - http://www.ncbi.nlm.nih.gov/pubmed/30401668 ID - info:doi/10.2196/resprot.9688 ER - TY - JOUR AU - Verdaguer, Sandra AU - Mateo, F. Katrina AU - Wyka, Katarzyna AU - Dennis-Tiwary, A. Tracy AU - Leung, May May PY - 2018/11/01 TI - A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study JO - JMIR Formativ Res SP - e21 VL - 2 IS - 2 KW - usability testing KW - interactive technology KW - mHealth, childhood obesity KW - minority KW - health nutrition KW - health education N2 - Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth. UR - http://formative.jmir.org/2018/2/e21/ UR - http://dx.doi.org/10.2196/formative.9747 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684417 ID - info:doi/10.2196/formative.9747 ER - TY - JOUR AU - Power, Mary Julianne AU - Bersamin, Andrea PY - 2018/07/06 TI - A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study JO - JMIR Formativ Res SP - e13 VL - 2 IS - 2 KW - fruits and vegetables KW - nutrition education KW - nutrition intervention KW - young children KW - text messaging N2 - Background: Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective: The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods: The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results: Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions: A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted. UR - http://formative.jmir.org/2018/2/e13/ UR - http://dx.doi.org/10.2196/formative.8544 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684412 ID - info:doi/10.2196/formative.8544 ER - TY - JOUR AU - Hanna, M. Reem AU - Fischer, Gary AU - Conroy, B. Molly AU - Bryce, Cindy AU - Hess, Rachel AU - McTigue, Kathleen PY - 2018/06/08 TI - Online Lifestyle Modification Intervention: Survey of Primary Care Providers? Attitudes and Views JO - J Med Internet Res SP - e167 VL - 20 IS - 6 KW - online intervention KW - obesity KW - health information technology KW - referral model N2 - Background: Online tools are a convenient and effective method of delivering lifestyle interventions to obese adult primary care patients. A referral model allows physicians to efficiently direct their patients to the intervention during a primary care visit. However, little is known of physicians? perspectives and utilization of the referral model for an online lifestyle modification intervention. Objective: The aim was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. Methods: The PCPs at six primary care clinics were asked to refer adult obese patients to a year-long online lifestyle intervention providing self-management support for weight loss. Following the 1-year intervention, all providers at the participating practices were surveyed regarding their views of the program. Respondents completed survey items assessing their attitudes regarding the 1-year intensive weight loss intervention and identifying resources they would find helpful for assisting patients with weight loss. Referring physicians were asked about their level of satisfaction with implementing the counseling services using standard electronic health record referral processes. Attitudes toward obesity counseling among referring and nonreferring providers were compared. Impressions of how smoothly the referral model of obesity treatment integrated with the clinical workflow were also quantified. Results: Of the 67 providers who completed the surveys, nonreferring providers (n=17) were more likely to prefer counseling themselves (P=.04) and to report having sufficient time to do so (P=.03) than referring providers (n=50) were. Nonreferring providers were more likely to report that their patients lacked computer skills (76%, 13/17 vs 34%, 17/50) or had less access to the Internet (65%, 11/17 vs 32%, 16/50). Conclusions: Understanding providers? views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention. UR - http://www.jmir.org/2018/6/e167/ UR - http://dx.doi.org/10.2196/jmir.8616 UR - http://www.ncbi.nlm.nih.gov/pubmed/29884605 ID - info:doi/10.2196/jmir.8616 ER - TY - JOUR AU - Vassallo, Jo Amy AU - Kelly, Bridget AU - Zhang, Lelin AU - Wang, Zhiyong AU - Young, Sarah AU - Freeman, Becky PY - 2018/06/05 TI - Junk Food Marketing on Instagram: Content Analysis JO - JMIR Public Health Surveill SP - e54 VL - 4 IS - 2 KW - food and beverage KW - advertisements KW - social media N2 - Background: Omnipresent marketing of processed foods is a key driver of dietary choices and brand loyalty. Market data indicate a shift in food marketing expenditures to digital media, including social media. These platforms have greater potential to influence young people, given their unique peer-to-peer transmission and youths? susceptibility to social pressures. Objective: The aim of this study was to investigate the frequency of images and videos posted by the most popular, energy-dense, nutrient-poor food and beverage brands on Instagram and the marketing strategies used in these images, including any healthy choice claims. Methods: A content analysis of 15 accounts was conducted, using 12 months of Instagram posts from March 15, 2015, to March 15, 2016. A pre-established hierarchical coding guide was used to identify the primary marketing strategy of each post. Results: Each brand used 6 to 11 different marketing strategies in their Instagram accounts; however, they often adhered to an overall theme such as athleticism or relatable consumers. There was a high level of branding, although not necessarily product information on all accounts, and there were very few health claims. Conclusions: Brands are using social media platforms such as Instagram to market their products to a growing number of consumers, using a high frequency of targeted and curated posts that manipulate consumer emotions rather than present information about their products. Policy action is needed that better reflects the current media environment. Public health bodies also need to engage with emerging media platforms and develop compelling social counter-marketing campaigns. UR - http://publichealth.jmir.org/2018/2/e54/ UR - http://dx.doi.org/10.2196/publichealth.9594 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/publichealth.9594 ER - TY - JOUR AU - Rosso, Nicholas AU - Giabbanelli, Philippe PY - 2018/05/30 TI - Accurately Inferring Compliance to Five Major Food Guidelines Through Simplified Surveys: Applying Data Mining to the UK National Diet and Nutrition Survey JO - JMIR Public Health Surveill SP - e56 VL - 4 IS - 2 KW - diet, food, and nutrition KW - public health informatics KW - supervised machine learning N2 - Background: National surveys in public health nutrition commonly record the weight of every food consumed by an individual. However, if the goal is to identify whether individuals are in compliance with the 5 main national nutritional guidelines (sodium, saturated fats, sugars, fruit and vegetables, and fats), much less information may be needed. A previous study showed that tracking only 2.89% of all foods (113/3911) was sufficient to accurately identify compliance. Further reducing the data needs could lower participation burden, thus decreasing the costs for monitoring national compliance with key guidelines. Objective: This study aimed to assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our dataset came from a generalized sample of inhabitants in the United Kingdom, more specifically from the National Diet and Nutrition Survey 2008-2012. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major 5 nutritional guidelines. Results: When using decision trees of a similar size to previous studies (ie, involving as many foods), we were able to correctly infer compliance for the 5 guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: Although one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner and possibly decrease the number of errors as participation burden is reduced. UR - http://publichealth.jmir.org/2018/2/e56/ UR - http://dx.doi.org/10.2196/publichealth.9536 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/publichealth.9536 ER - TY - JOUR AU - Quick, Virginia PY - 2018/04/25 TI - Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e10320 VL - 1 IS - 1 KW - obesity KW - family KW - preschool children KW - socioecological KW - risk factors KW - environment KW - home KW - physical activity KW - screen time N2 - Background: Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk. Objective: The purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children. Methods: Mothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother?s fruit and vegetable intake ?5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward?s method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings. Results: Of the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (?5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward?s hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion). Conclusions: Findings may have implications in tailoring future obesity prevention interventions among families with young children. UR - http://pediatrics.jmir.org/2018/1/e10320/ UR - http://dx.doi.org/10.2196/10320 UR - http://www.ncbi.nlm.nih.gov/pubmed/31518289 ID - info:doi/10.2196/10320 ER - TY - JOUR AU - Russell, Georgina Catherine AU - Denney-Wilson, Elizabeth AU - Laws, A. Rachel AU - Abbott, Gavin AU - Zheng, Miaobing AU - Lymer, J. Sharyn AU - Taki, Sarah AU - Litterbach, V. Eloise-Kate AU - Ong, Kok-Leong AU - Campbell, J. Karen PY - 2018/04/25 TI - Impact of the Growing Healthy mHealth Program on Maternal Feeding Practices, Infant Food Preferences, and Satiety Responsiveness: Quasi-Experimental Study JO - JMIR Mhealth Uhealth SP - e77 VL - 6 IS - 4 KW - mHealth KW - obesity KW - infant KW - parents KW - food preferences KW - appetite KW - pediatric obesity KW - feeding behavior KW - overweight KW - eating KW - health promotion N2 - Background: Infancy is an important life stage for obesity prevention efforts. Parents? infant feeding practices influence the development of infants? food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content. Objective: The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness. Methods: A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (?Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant?s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes. Results: A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (P=.001). All but one (IFQ subscale ?concerns about infant overeating or becoming overweight? at T2) of the measured outcomes did not differ between Growing Healthy and Baby's First Food. Conclusions: Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results. UR - http://mhealth.jmir.org/2018/4/e77/ UR - http://dx.doi.org/10.2196/mhealth.9303 UR - http://www.ncbi.nlm.nih.gov/pubmed/29695373 ID - info:doi/10.2196/mhealth.9303 ER - TY - JOUR AU - Lopes, Carla AU - Torres, Duarte AU - Oliveira, Andreia AU - Severo, Milton AU - Guiomar, Sofia AU - Alarcão, Violeta AU - Ramos, Elisabete AU - Rodrigues, Sara AU - Vilela, Sofia AU - Oliveira, Luísa AU - Mota, Jorge AU - Teixeira, J. Pedro AU - Nicola, J. Paulo AU - Soares, Simão AU - Andersen, Frost Lene AU - PY - 2018/02/15 TI - National Food, Nutrition, and Physical Activity Survey of the Portuguese General Population (2015-2016): Protocol for Design and Development JO - JMIR Res Protoc SP - e42 VL - 7 IS - 2 KW - surveys KW - nutritional surveys KW - exercise KW - public health KW - children KW - adults KW - elderly N2 - Background: The assessment of food consumption data using harmonized methodologies at the European level is fundamental to support the development of public policies. Portugal is one of the countries with the most outdated information on individual food consumption. Objective: The objective of this study was to describe the design and methodology of the National Food, Nutrition and Physical Activity Survey, 2015-2016, developed to collect national and regional data on dietary habits, physical activity (PA), and nutritional status, in a representative sample of the Portuguese general population (3 months-84 years). Methods: Participants were selected by multistage sampling, using the National Heath Registry as the sampling frame. Data collection, during 12 months, was harmonized according to European guidelines (EU-MENU, European Food Safety Authority [EFSA]). Computer-assisted personal interviewing (CAPI) was performed on a specific electronic platform synchronized with nutritional composition data and considering the FoodEx2 classification system. Dietary assessment was performed using 24-hour recalls (two nonconsecutive, 8-15 days apart) or food diaries in the case of children aged <10 years, complemented with a food propensity questionnaire; PA data (International Physical Activity Questionnaire [IPAQ], the Activity Choice Index [ACI], and 4-days PA diaries); sociodemographic data, and other health-related data were also collected. Results: A sample of 6553 individuals completed the first interview, and 5811 participants completed two dietary assessments. The participation rate among eligible individuals was 33.38% (6553/19,635), considering the first interview, and 29.60% (5811/19,635) for the participants with two completed interviews (about 40% in children and adolescents and 20% in elderly individuals). Results of the survey will be disseminated in national and international scientific journals during 2018-2019. Conclusions: The survey will assist policy planning and management of national and European health programs on the improvement of nutritional status and risk assessment related to food hazards, and the enhancement of PA. The infrastructures and data driven from this Survey are a solid basis to the development of a future national surveillance system on diet, PA, and other health behaviors reproducible over time. UR - http://www.researchprotocols.org/2018/2/e42/ UR - http://dx.doi.org/10.2196/resprot.8990 UR - http://www.ncbi.nlm.nih.gov/pubmed/29449204 ID - info:doi/10.2196/resprot.8990 ER - TY - JOUR AU - Vilchis-Gil, Jenny AU - Klünder-Klünder, Miguel AU - Flores-Huerta, Samuel PY - 2018/02/05 TI - Effect on the Metabolic Biomarkers in Schoolchildren After a Comprehensive Intervention Using Electronic Media and In-Person Sessions to Change Lifestyles: Community Trial JO - J Med Internet Res SP - e44 VL - 20 IS - 2 KW - obesity KW - child KW - early intervention (education) KW - insulin resistance KW - biomarkers N2 - Background: Obesity is a chronic low-intensity state of inflammation with metabolic alterations that, when acquired during childhood, lead to severe illness in adults. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications. Objective: To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children?s metabolic biomarkers. Methods: Of four Mexico City primary schools in this study, two groups of children that were recruited at their schools were assigned to a 12-month intervention group (IG) and the other two were assigned to control groups (CGs). The intervention had two components: (1) parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits, and were provided printed information; and (2) parents were able to seek information through a website, and also received brief weekly mobile phone text messages. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months. Results: The study involved 187 children in the IG and 128 in the CG. Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (?1.83; CI 95% ?3.06 to -0.60), low-density lipoprotein-cholesterol (?2.59; CI 95% ?5.12 to ?0.06), insulin (?0.84; CI 95% ?1.31 to ?0.37), and homeostasis model to assess the insulin resistance index (HOMA-IR; ?0.21; CI 95% ?0.32 to ?0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline body mass index z-scores. Conclusions: Intervention through multiple components that promoted healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status. UR - http://www.jmir.org/2018/2/e44/ UR - http://dx.doi.org/10.2196/jmir.9052 UR - http://www.ncbi.nlm.nih.gov/pubmed/29402762 ID - info:doi/10.2196/jmir.9052 ER - TY - JOUR AU - Nakamura, Saki AU - Inayama, Takayo AU - Harada, Kazuhiro AU - Arao, Takashi PY - 2017/11/24 TI - Reduction in Vegetable Intake Disparities With a Web-Based Nutrition Education Intervention Among Lower-Income Adults in Japan: Randomized Controlled Trial JO - J Med Internet Res SP - e377 VL - 19 IS - 11 KW - vegetable intake KW - adults KW - socioeconomic disadvantage KW - Web-based nutrition intervention KW - randomized controlled trial N2 - Background: No existing Web-based nutrition education interventions have been evaluated in light of socioeconomic status just in Japan. Objective: The aim was to investigate the effect of a Web-based intervention program on reducing vegetable intake disparities between low- and middle-income Japanese adults. Methods: In this randomized controlled trial, participants were assessed at three time points?baseline, postintervention (5 weeks later), and a follow-up after 3 months?from October 2015 to March 2016. We collected data via a Japanese online research service company from 8564 adults aged 30 to 59 years. Participants were stratified according to national population statistics for gender and age, and randomly selected. They were then randomly allocated into intervention (n=900) and control (n=600) groups such that both groups contained an equal number of individuals with low and middle income. The intervention program encouraged behavior change using behavioral theories and techniques tailored to their assumed stage of change. The outcome was vegetable intake servings per day (1 serving being approximately 70 g). Results: Out of 900 participants who started, 450 were from the middle income group (of which 386 or 85.7% completed the intervention), and 450 were from the low income group (of which 371 or 82.4% completed). In the intervention group, vegetable intake increased in the low-income participants from baseline to postintervention (0.42 servings, 95% CI 0.11-0.72). A two-way analysis of variance showed that low-income participants had significant main effects of group (?2=0.04, P=.01) and time (?2=0.01, P<.001), and a significant interaction (?2=0.01, P=.009). Middle-income participants also had a significant main effect of time (?2=0.01, P=.006) and a significant interaction (?2=0.01, P=.046). Conclusions: This Web-based nutritional education intervention could fill the vegetable intake gap between low- and middle-income adults in Japan, and is expected to prevent noncommunicable and lifestyle-related diseases. Further intervention program improvements are necessary to maintain and increase vegetable intake for other groups. Trial Registration: Current Controlled Trials (UMIN-ICDR): UMIN000019376; https://upload.umin.ac.jp/cgi-open-bin/ icdr_e/ctr_view.cgi?recptno=R000022404 (Archived by WebCite at http://www.webcitation.org/6u9wihBZU) UR - http://www.jmir.org/2017/11/e377/ UR - http://dx.doi.org/10.2196/jmir.8031 UR - http://www.ncbi.nlm.nih.gov/pubmed/29175810 ID - info:doi/10.2196/jmir.8031 ER - TY - JOUR AU - Monroe, M. Courtney AU - Turner-McGrievy, Gabrielle AU - Larsen, A. Chelsea AU - Magradey, Karen AU - Brandt, M. Heather AU - Wilcox, Sara AU - Sundstrom, Beth AU - West, Smith Delia PY - 2017/10/12 TI - College Freshmen Students? Perspectives on Weight Gain Prevention in the Digital Age: Web-Based Survey JO - JMIR Public Health Surveill SP - e71 VL - 3 IS - 4 KW - weight gain prevention KW - college freshmen KW - social media N2 - Background: College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students? perspectives on weight gain prevention and related lifestyle behaviors. Objective: The objective of this study was to assess college freshmen students? concern about weight gain and associated topics, as well as their interest in and delivery medium preferences for eHealth programs focused on these topics. Methods: Web-based surveys that addressed college freshmen students? (convenience sample of N=50) perspectives on weight gain prevention were administered at the beginning and end of the fall 2015 semester as part of a longitudinal investigation of health-related issues and experiences in first semester college freshmen. Data on weight gain prevention-related concerns and corresponding interest in eHealth programs targeting topics of potential concern, as well as preferred program delivery medium and current technology use were gathered and analyzed using descriptive statistics. Results: A considerable proportion of the freshmen sample expressed concern about weight gain (74%, 37/50) and both traditional (healthy diet: 86%, 43/50; physical activity: 64%, 32/50) and less frequently addressed (stress: 82%, 41/50; sleep: 74%, 37/50; anxiety and depression: 60%, 30/50) associated topics within the context of behavioral weight gain prevention. The proportion of students who reported interest in eHealth promotion programs targeting these topics was also generally high (ranging from 52% [26/50] for stress management to 70% [35/50] for eating a healthy diet and staying physically active). Email was the most frequently used electronic platform, with 96% (48/50) of students reporting current use of it. Email was also the most frequently cited preferred eHealth delivery platform, with 86% (43/50) of students selecting it. Facebook was preferred by the second greatest proportion of students (40%, 20/50). Conclusions: Most college freshmen have concerns about an array of weight gain prevention topics and are generally open to the possibility of receiving eHealth interventions designed to address their concerns, preferably via email compared with popular social media platforms. These preliminary findings offer a foundation to build upon when it comes to future descriptive investigations focused on behavioral weight gain prevention among college freshmen in the digital age. UR - http://publichealth.jmir.org/2017/4/e71/ UR - http://dx.doi.org/10.2196/publichealth.7875 UR - http://www.ncbi.nlm.nih.gov/pubmed/29025698 ID - info:doi/10.2196/publichealth.7875 ER - TY - JOUR AU - Akindele, Oyeniran Mukadas AU - Phillips, Joliana AU - Igumbor, Ehimario AU - Useh, Ushotanefe PY - 2017/08/16 TI - Body Weight Misperception and Dissatisfaction Among Overweight and Obese Adult Nigerians JO - JMIR Public Health Surveill SP - e56 VL - 3 IS - 3 KW - overweight KW - obesity KW - misperception KW - Nigeria KW - adult N2 - Background: The increase in the prevalence of overweight and obesity in low- and medium-income countries has a negative impact on overall health. Correct perception of one?s body weight is a step in seeking healthy help toward weight reduction in overweight and obese individuals. Objective: This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting. Methods: This study was part of a larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in an urban African setting. For this study, we randomly selected only overweight and obese adults (?18 years old) who consented to participate in the study from 15 enumeration areas in Alimosho Local Government Area of Lagos State, Nigeria. We followed the World Health Organization guidelines for conducting community surveys in recruiting overweight and obese participants. We assessed body weight perception and dissatisfaction through their responses to the following: ?How do you describe your weight?? and ?I feel bad about myself because of my weight.? Data for this study were collected between November 2012 and March 2013. Results: We recruited 567 participants, of whom more than half (n=304, 53.6%) misperceived their weight as either underweight or normal weight, and 61.2% (n=186) of whom were women. The strength of agreement between the actual body mass index and weight perception was very poor (?=.032, SE .015, P=.04). The strongest predictor of weight perception was sex (female) with an odds ratio of 1.63 (95% CI 1.13-2.35). About 41.1% (n=233) of the participants were dissatisfied with their weight, of whom 30.0% (n=70) were men. Age (young adult) was a predictor of weight dissatisfaction with an odds ratio of 2.37 (95% CI 1.62-3.46). Conclusions: More than half of the participants misperceived their body weight as either underweight or normal weight, and the majority of them were women. More men were not happy with their body weight, and participants in the young adult age group were more dissatisfied with their body weight. UR - http://publichealth.jmir.org/2017/3/e56/ UR - http://dx.doi.org/10.2196/publichealth.7047 UR - http://www.ncbi.nlm.nih.gov/pubmed/28814377 ID - info:doi/10.2196/publichealth.7047 ER - TY - JOUR AU - Bedard, Chloe AU - King-Dowling, Sara AU - McDonald, Madeline AU - Dunton, Genevieve AU - Cairney, John AU - Kwan, Matthew PY - 2017/05/31 TI - Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary Assessment in the MovingU Study JO - JMIR Public Health Surveill SP - e32 VL - 3 IS - 2 KW - exercise KW - compliance KW - feasibility studies KW - young adult KW - students N2 - Background: It is well established that drastic declines in physical activity (PA) occur during young adults? transition into university; however, our understanding of contextual and environmental factors as it relates to young adults? PA is limited. Objective: The purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university. Methods: First-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days. Results: A total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ?2 days of ?10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ?3 days of 3 prompts/day or ?4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ?5 days of 4 prompts/day or ? 4 days of 5 prompts/day). Conclusions: This study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA. UR - http://publichealth.jmir.org/2017/2/e32/ UR - http://dx.doi.org/10.2196/publichealth.7010 UR - http://www.ncbi.nlm.nih.gov/pubmed/28566264 ID - info:doi/10.2196/publichealth.7010 ER - TY - JOUR AU - Lindsay, Cristina Ana AU - Mesa, Tatiana AU - Greaney, L. Mary AU - Wallington, F. Sherrie AU - Wright, A. Julie PY - 2017/05/26 TI - Associations Between Maternal Depressive Symptoms and Nonresponsive Feeding Styles and Practices in Mothers of Young Children: A Systematic Review JO - JMIR Public Health Surveill SP - e29 VL - 3 IS - 2 KW - maternal depression KW - child KW - feeding behavior KW - practices KW - feeding styles KW - obesity N2 - Background: Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children?s eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity. Objective: The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed. Results: The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association. Conclusions: This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs. UR - http://publichealth.jmir.org/2017/2/e29/ UR - http://dx.doi.org/10.2196/publichealth.6492 UR - http://www.ncbi.nlm.nih.gov/pubmed/28550007 ID - info:doi/10.2196/publichealth.6492 ER - TY - JOUR AU - Fernandes Davies, Vanessa AU - Kupek, Emil AU - Faria Di Pietro, Patricia AU - Altenburg de Assis, Alice Maria AU - GK Vieira, Francilene AU - Perucchi, Clarice AU - Mafra, Rafaella AU - Thompson, Debbe AU - Baranowski, Thomas PY - 2016/11/28 TI - Qualitative Analysis of Cognitive Interviews With School Children: A Web-Based Food Intake Questionnaire JO - JMIR Public Health Surveill SP - e167 VL - 2 IS - 2 KW - dietary assessment KW - children KW - computer KW - questionnaire N2 - Background: The use of computers to administer dietary assessment questionnaires has shown potential, particularly due to the variety of interactive features that can attract and sustain children?s attention. Cognitive interviews can help researchers to gain insights into how children understand and elaborate their response processes in this type of questionnaire. Objective: To present the cognitive interview results of children who answered the WebCAAFE, a Web-based questionnaire, to obtain an in-depth understanding of children?s response processes. Methods: Cognitive interviews were conducted with children (using a pretested interview script). Analyses were carried out using thematic analysis within a grounded theory framework of inductive coding. Results: A total of 40 children participated in the study, and 4 themes were identified: (1) the meaning of words, (2) understanding instructions, (3) ways to resolve possible problems, and (4) suggestions for improving the questionnaire. Most children understood questions that assessed nutritional intake over the past 24 hours, although the structure of the questionnaire designed to facilitate recall of dietary intake was not always fully understood. Younger children (7 and 8 years old) had more difficulty relating the food images to mixed dishes and foods eaten with bread (eg, jam, cheese). Children were able to provide suggestions for improving future versions of the questionnaire. Conclusions: More attention should be paid to children aged 8 years or below, as they had the greatest difficulty completing the WebCAAFE. UR - http://publichealth.jmir.org/2016/2/e167/ UR - http://dx.doi.org/10.2196/publichealth.5024 UR - http://www.ncbi.nlm.nih.gov/pubmed/27895005 ID - info:doi/10.2196/publichealth.5024 ER - TY - JOUR AU - Rivera, Jordan AU - McPherson, Amy AU - Hamilton, Jill AU - Birken, Catherine AU - Coons, Michael AU - Iyer, Sindoora AU - Agarwal, Arnav AU - Lalloo, Chitra AU - Stinson, Jennifer PY - 2016/07/26 TI - Mobile Apps for Weight Management: A Scoping Review JO - JMIR Mhealth Uhealth SP - e87 VL - 4 IS - 3 KW - weight loss KW - obesity KW - mobile apps KW - smartphones KW - mHealth N2 - Background: Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for ?weight loss apps? has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective: To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods: An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results: A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions: Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps? claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets. UR - http://mhealth.jmir.org/2016/3/e87/ UR - http://dx.doi.org/10.2196/mhealth.5115 UR - http://www.ncbi.nlm.nih.gov/pubmed/27460502 ID - info:doi/10.2196/mhealth.5115 ER - TY - JOUR AU - Hammersley, L. Megan AU - Jones, A. Rachel AU - Okely, D. Anthony PY - 2016/7/21 TI - Parent-Focused Childhood and Adolescent Overweight and Obesity eHealth Interventions: A Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e203 VL - 18 IS - 7 KW - overweight KW - obesity KW - child KW - adolescent KW - internet KW - web KW - online KW - computer KW - IVR KW - telemedicine KW - healthy lifestyle KW - dietary intake KW - physical activity N2 - Background: Effective broad-reach interventions to reduce childhood obesity are needed, but there is currently little consensus on the most effective approach. Parental involvement in interventions appears to be important. The use of eHealth modalities in interventions also seems to be promising. To our knowledge, there have been no previous reviews that have specifically investigated the effectiveness of parent-focused eHealth obesity interventions, a gap that this systematic review and meta-analysis intends to address. Objective: The objective of this study was to review the evidence for body mass index (BMI)/BMI z-score improvements in eHealth overweight and obesity randomized controlled trials for children and adolescents, where parents or carers were an agent of change. Methods: A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Seven databases were searched for the period January 1995 to April 2015. Primary outcome measures were BMI and/or BMI z-score at baseline and post-intervention. Secondary outcomes included diet, physical activity, and screen time. Interventions were included if they targeted parents of children and adolescents aged 0-18 years of age and used an eHealth medium such as the Internet, interactive voice response (IVR), email, social media, telemedicine, or e-learning. Results: Eight studies were included, involving 1487 parent and child or adolescent dyads. A total of 3 studies were obesity prevention trials, and 5 were obesity treatment trials. None of the studies found a statistically significant difference in BMI or BMI z-score between the intervention and control groups at post-intervention, and a meta-analysis demonstrated no significant difference in the effects of parent-focused eHealth obesity interventions compared with a control on BMI/BMI z-score (Standardized Mean Difference ?0.15, 95% CI ?0.45 to 0.16, Z=0.94, P=.35). Four of seven studies that reported on dietary outcomes demonstrated significant improvements in at least 1 dietary measurement, and 1 of 6 studies that reported on physical activity outcomes demonstrated significant improvements compared with the control. The quality of the interventions was generally not high; therefore, these results should be interpreted with caution. Conclusion: It is recommended that larger, longer duration, high-quality parent-focused eHealth studies are conducted, which transform successful components from face-to-face interventions into an eHealth format and target younger age groups in particular. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015019837; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015019837 (Archived by WebCite at http://www.webcitation.org/6ivBHvBhq) UR - http://www.jmir.org/2016/7/e203/ UR - http://dx.doi.org/10.2196/jmir.5893 UR - http://www.ncbi.nlm.nih.gov/pubmed/27443862 ID - info:doi/10.2196/jmir.5893 ER - TY - JOUR AU - Connelly, Kay AU - Stein, F. Karen AU - Chaudry, Beenish AU - Trabold, Nicole PY - 2016/07/14 TI - Development of an Ecological Momentary Assessment Mobile App for a Low-Literacy, Mexican American Population to Collect Disordered Eating Behaviors JO - JMIR Public Health Surveill SP - e31 VL - 2 IS - 2 KW - feeding and eating disorders KW - health literacy KW - socioeconomic status KW - human-centered computing KW - user-computer interface KW - mobile apps N2 - Background: Ecological momentary assessment (EMA) is a popular method for understanding population health in which participants report their experiences while in naturally occurring contexts in order to increase the reliability and ecological validity of the collected data (as compared to retrospective recall). EMA studies, however, have relied primarily on text-based questionnaires, effectively eliminating low-literacy populations from the samples. Objective: To provide a case study of design of an EMA mobile app for a low-literacy population. In particular, we present the design process and final design of an EMA mobile app for low literate, Mexican American women to record unhealthy eating and weight control behaviors (UEWCBs). Methods: An iterative, user-centered design process was employed to develop the mobile app. An existing EMA protocol to measure UEWCBs in college-enrolled Mexican American women was used as the starting point for the application. The app utilizes an icon interface, with optional audio prompts, that is culturally sensitive and usable by a low-literacy population. A total of 41 women participated over the course of 4 phases of the design process, which included 2 interview and task-based phases (n=8, n=11), focus groups (n=15), and a 5-day, in situ deployment (n=7). Results: Participants? mental models of UEWCBs differed substantially from prevailing definitions found in the literature, prompting a major reorganization of the app interface. Differences in health literacy and numeracy were better identified with the Newest Vital Sign tool, as compared with the Short Assessment of Health Literacy tool. Participants had difficulty imagining scenarios in the interviews to practice recording a specific UEWCB; instead, usability was best tested in situ. Participants were able to use the EMA mobile app over the course of 5 days to record UEWCBs. Conclusions: Results suggest that the iterative, user-centered design process was essential for designing the app to be made usable by the target population. Simply taking the protocol designed for a higher-literacy population and replacing words with icons and/or audio would have been unsuccessful with this population. UR - http://publichealth.jmir.org/2016/2/e31/ UR - http://dx.doi.org/10.2196/publichealth.5511 UR - http://www.ncbi.nlm.nih.gov/pubmed/27418020 ID - info:doi/10.2196/publichealth.5511 ER - TY - JOUR AU - Zaidan, Sarah AU - Roehrer, Erin PY - 2016/07/11 TI - Popular Mobile Phone Apps for Diet and Weight Loss: A Content Analysis JO - JMIR Mhealth Uhealth SP - e80 VL - 4 IS - 3 KW - applications KW - diet KW - monitoring KW - obesity KW - weight loss N2 - Background: A review of the literature has revealed that the rates of overweight and obesity have been increasing in Australia over the last two decades and that wellness mobile phone apps play a significant role in monitoring and managing individuals? weight. Although mobile phone app markets (iTunes and Google Play) list thousands of mobile phone health apps, it is not always clear whether those apps are supported by credible sources. Likewise, despite the prevailing use of mobile phone apps to aid with weight management, the usability features of these apps are not well characterized. Objective: The research explored how usability taxonomy could inform the popularity of downloaded, socially focused wellness mobile phone apps, in particular weight loss and diet apps. The aim of the study was to investigate the Australian mobile phone app stores (iTunes and Google Play) in order to examine the usability features of the most popular (ie, most downloaded) wellness apps. Methods: The design of this study comprises 3 main stages: stage 1, identifying apps; stage 2, development of weight loss and diet evaluation framework; and stage 3, application of the evaluation framework. Each stage includes specific data collection, analysis tools, and techniques. Results: The study has resulted in the development of a justified evaluation framework for weight loss and diet mobile phone apps. Applying the evaluation framework to the identified apps has shown that the most downloaded iTunes and Google Play apps are not necessarily the most usable or effective. In addition, the research found that search algorithms for iTunes and Google Play are biased toward apps? titles and keywords that do not accurately define the real functionality of the app. Moreover, the study has also analyzed the apps? user reviews, which served as justification for the developed evaluation framework. Conclusions: The analysis has shown that ease of use, reminder, bar code scanning, motivation, usable for all, and synchronization are significant attributes that should be included in weight loss and diet mobile phone apps and ultimately in potential weight loss and diet evaluation frameworks. UR - http://mhealth.jmir.org/2016/3/e80/ UR - http://dx.doi.org/10.2196/mhealth.5406 UR - http://www.ncbi.nlm.nih.gov/pubmed/27400806 ID - info:doi/10.2196/mhealth.5406 ER - TY - JOUR AU - Gopalan, Anjali AU - Makelarski, A. Jennifer AU - Garibay, B. Lori AU - Escamilla, Veronica AU - Merchant, M. Raina AU - Wolfe Sr, B. Marcus AU - Holbrook, Rebecca AU - Lindau, Tessler Stacy PY - 2016/06/28 TI - Health-Specific Information and Communication Technology Use and Its Relationship to Obesity in High-Poverty, Urban Communities: Analysis of a Population-Based Biosocial Survey JO - J Med Internet Res SP - e182 VL - 18 IS - 6 KW - obesity KW - technology KW - Internet KW - urban health N2 - Background: More than 35% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may substitute for or complement community-based resources for weight management. However, little is currently known about health-specific ICT use among urban-dwelling people with obesity. Objective: We describe health-specific ICT use and its relationship to measured obesity among adults in high-poverty urban communities. Methods: Using data collected between November 2012 and July 2013 from a population-based probability sample of urban-dwelling African American and Hispanic adults residing on the South Side of Chicago, we described patterns of ICT use in relation to measured obesity defined by a body mass index (BMI) of ?30 kg/m2. Among those with BMI?30 kg/m2, we also assessed the association between health-specific ICT use and diagnosed versus undiagnosed obesity as well as differences in health-specific ICT use by self-reported comorbidities, including diabetes and hypertension. Results: The survey response rate was 44.6% (267 completed surveys/598.4 eligible or likely eligible individuals); 53.2% were African American and 34.6% were Hispanic. More than 35% of the population reported an annual income of less than US $25,000. The population prevalence of measured obesity was 50.2%. People with measured obesity (BMI?30 kg/m2) were more likely to report both general (81.5% vs 67.0%, P=.04) and health-specific (61.1% vs 41.2%, P=.01) ICT use. In contrast, among those with measured obesity, being told of this diagnosis by a physician was not associated with increased health-specific ICT use. People with measured obesity alone had higher rates of health-specific use than those with comorbid hypertension and/or diabetes diagnoses (77.1% vs 60.7% vs 47.4%, P=.04). Conclusions: In conclusion, ICT-based health resources may be particularly useful for people in high-poverty urban communities with isolated measured obesity, a population that is at high risk for poor health outcomes. UR - http://www.jmir.org/2016/6/e182/ UR - http://dx.doi.org/10.2196/jmir.5741 UR - http://www.ncbi.nlm.nih.gov/pubmed/27352770 ID - info:doi/10.2196/jmir.5741 ER - TY - JOUR AU - Chrisman, Matthew AU - Chow, Wong-Ho AU - Daniel, R. Carrie AU - Wu, Xifeng AU - Zhao, Hua PY - 2016/06/16 TI - Mobile Phone Use and its Association With Sitting Time and Meeting Physical Activity Recommendations in a Mexican American Cohort JO - JMIR Mhealth Uhealth SP - e54 VL - 4 IS - 2 KW - mobile phone KW - physical activity KW - Mexican Americans KW - sedentary lifestyle N2 - Background: The benefits of physical activity (PA) are well-documented. Mobile phones influence PA by promoting screen-based sedentary time, providing prompts or reminders to be active, aiding in tracking and monitoring PA, or providing entertainment during PA. It is not known how mobile phone use is associated with PA and sitting time in Mexican Americans, and how mobile phone users may differ from nonusers. Objective: To determine the associations between mobile phone use, PA, and sitting time and how these behaviors differ from mobile phone nonusers in a sample of 2982 Mexican-American adults from the Mano a Mano cohort. Methods: Differences in meeting PA recommendations and sitting time between mobile phone users and nonusers were examined using chi-square and analysis of variance tests. Logistic regression was used to examine associations between mobile phone use, PA, and sitting. Results: Mobile phone users were more likely to be obese by body mass index criteria (?30 kg/m2), younger, born in the United States and lived there longer, more educated, and sit more hours per day but more likely to meet PA recommendations than nonusers. Males (odds ratio [OR] 1.42, 95% CI 1.16-1.74), use of text messaging (OR 1.26, 95% CI 1.03-1.56), and having a higher acculturation score (OR 1.27, 95% CI 1.07-1.52) were associated with higher odds of meeting PA recommendations. Sitting more hours per day was associated with being male, obese, born in the United States, a former alcohol drinker, and having at least a high school education. Among nonusers, being born in the United States was associated with higher odds of more sitting time, and being married was associated with higher odds of meeting PA recommendations. Conclusions: Mobile phone interventions using text messages could be tailored to promote PA in less acculturated and female Mexican American mobile phone users. UR - http://mhealth.jmir.org/2016/2/e54/ UR - http://dx.doi.org/10.2196/mhealth.4926 UR - http://www.ncbi.nlm.nih.gov/pubmed/27311831 ID - info:doi/10.2196/mhealth.4926 ER - TY - JOUR AU - Lynch, Sarah AU - Hayes, Sharon AU - Napolitano, Melissa AU - Hufnagel, Katrina PY - 2016/06/08 TI - Availability and Accessibility of Student-Specific Weight Loss Programs and Other Risk Prevention Health Services on College Campuses JO - JMIR Public Health Surveill SP - e29 VL - 2 IS - 1 KW - weight loss KW - student health services KW - students KW - universities N2 - Background: More than one third of college students who are overweight or obese are in need of weight loss programs tailored to college students. However, the availability and accessibility of these programs is unknown. Objective: The aim of this study is to examine the availability and ease of access to weight loss programs for students at 10 universities with the largest undergraduate enrollment. Methods: The 10 public universities with the largest student bodies with a mean (SD) undergraduate enrollment of 41,122 (7657) students were examined. The websites of the universities were assessed to determine the availability of weight loss programs. Services for high-risk health needs common to university campuses (ie, alcohol and other drugs, victim services, sexual health, and eating disorders) were searched. Results: Of the universities searched, 3 (30%, 3/10) offered weight loss programming, however, none met the predetermined criteria. Comparatively, all schools (100%, 10/10) offered no-cost and continual enrollment programming for the other high-risk health needs. Conclusions: There are limited weight loss services available to undergraduate students compared with other university services. Collaboration between existing college health service providers is suggested for the delivery of appropriate programming for overweight and obese undergraduates wanting to lose weight. UR - http://publichealth.jmir.org/2016/1/e29/ UR - http://dx.doi.org/10.2196/publichealth.5166 UR - http://www.ncbi.nlm.nih.gov/pubmed/27278261 ID - info:doi/10.2196/publichealth.5166 ER - TY - JOUR AU - Norman, D. Cameron AU - Haresign, Helen AU - Mehling, Christine AU - Bloomberg, Honey PY - 2016/04/19 TI - Exploring the Feasibility and Potential of Virtual Panels for Soliciting Feedback on Nutrition Education Materials: A Proof-of-Concept Study JO - JMIR Public Health Surveill SP - e18 VL - 2 IS - 1 KW - health communications KW - Facebook KW - marketing KW - nutrition KW - nutrition education KW - healthy eating KW - health education KW - design KW - study design KW - social media KW - user design KW - qualitative data KW - health promotion KW - public health N2 - Background: A changing and cluttered information landscape has put pressure on health organizations to produce consumer information materials that are not only factual but high quality and engaging to audiences. User-centered design methods can be useful in obtaining feedback from consumers; however, they are labor intensive and slow, which is not responsive to the fast-paced communication landscape influenced by social media. EatRight Ontario (ERO), a provincial nutrition and health support program of Dietitians of Canada, develops evidence-based resources for consumers and sought to increase user-centered design activities by exploring whether the standard approach to feedback could be replicated online. While online feedback has been used in marketing research, few examples are available in health promotion and public health to guide programming and policy. Objective: This study compared a traditional in-person approach for recruitment and feedback using paper surveys with an Internet-based approach using Facebook as a recruitment tool and collecting user feedback via the Web. The purpose of the proof-of-concept study was to explore the feasibility of the approach and compare an online versus traditional approach in terms of recruitment issues and response. Methods: An exploratory, two-group comparative trial was conducted using a convenience and purposive sampling. Participants reviewed a handout on healthy eating and then completed an 18-item survey with both forced-choice items and open-ended responses. One group viewed a hard-copy prototype and completed a paper survey and the other viewed a PDF prototype via Web links and completed a Web survey. The total days required to fulfill the sample for each group were used as the primary method of efficiency calculation. Results: In total, 44 participants (22 per condition) completed the study, consisting of 42 women and 2 men over the age of 18. Few significant differences were detected between the groups. Statistically significant (P?.05) differences were detected on four attitudinal variables related to the document reviewed and include perceived length of the document, perceived attractiveness, likelihood of contacting ERO for food and nutrition questions in the future, and likelihood of recommending ERO to a friend. In all cases, the responses were more favorable to the document or ERO with the online group. All other variables showed no difference between them. A content review of the qualitative feedback found relative consistency in word use and number of words used, indicating relative parity in the amount of data generated between conditions. The online condition achieved its sampling target in 9 days, while the in-person method took 79 days to achieve the target. Conclusions: An online process of recruitment through Facebook and solicitation of online feedback is a feasible model that yields comparable response levels to in-person methods for user feedback. The online approach appears to be a faster and less resource-intensive approach than traditional in-person methods for feedback generation. UR - http://publichealth.jmir.org/2016/1/e18/ UR - http://dx.doi.org/10.2196/publichealth.5134 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227153 ID - info:doi/10.2196/publichealth.5134 ER - TY - JOUR AU - Cadmus-Bertram, Lisa AU - Marcus, H. Bess AU - Patterson, E. Ruth AU - Parker, A. Barbara AU - Morey, L. Brittany PY - 2015/11/19 TI - Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks JO - JMIR mHealth uHealth SP - e96 VL - 3 IS - 4 KW - exercise KW - health behavior KW - health promotion KW - Internet KW - mHealth KW - motor activity KW - physical activity KW - technology KW - women N2 - Background: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area. Objective: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker. Methods: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16. Results: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated ?fairly active? and ?very active? minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks. Conclusions: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention. Trial Registration: Clinicaltrials.gov NCT01837147; http://clinicaltrials.gov/ct2/show/NCT01837147 (Archived by WebCite at http://www.webcitation.org/6d0VeQpvB) UR - http://mhealth.jmir.org/2015/4/e96/ UR - http://dx.doi.org/10.2196/mhealth.4229 UR - http://www.ncbi.nlm.nih.gov/pubmed/26586418 ID - info:doi/10.2196/mhealth.4229 ER - TY - JOUR AU - Hartley, Stefanie AU - Garland, Suzanne AU - Young, Elisa AU - Bennell, Louise Kim AU - Tay, Ilona AU - Gorelik, Alexandra AU - Wark, Dennis John PY - 2015/10/05 TI - A Comparison of Self-Reported and Objective Physical Activity Measures in Young Australian Women JO - JMIR Public Health Surveill SP - e14 VL - 1 IS - 2 KW - physical activity KW - exercise KW - women?s health KW - questionnaires N2 - Background: The evidence for beneficial effects of recommended levels of physical activity is overwhelming. However, 70% of Australians fail to meet these levels. In particular, physical activity participation by women falls sharply between ages 16 to 25 years. Further information about physical activity measures in young women is needed. Self-administered questionnaires are often used to measure physical activity given their ease of application, but known limitations, including recall bias, compromise the accuracy of data. Alternatives such as objective measures are commonly used to overcome this problem, but are more costly and time consuming. Objective: To compare the output between the Modified Active Australia Survey (MAAS), the International Physical Activity Questionnaire (IPAQ), and an objective physical activity measure?the SenseWear Armband (SWA)?to evaluate the test-retest reliability of the MAAS and to determine the acceptability of the SWA among young women. Methods: Young women from Victoria, Australia, aged 18 to 25 years who had participated in previous studies via Facebook advertising were recruited. Participants completed the two physical activity questionnaires online, immediately before and after wearing the armband for 7 consecutive days. Data from the SWA was blocked into 10-minute activity times. Follow-up IPAQ, MAAS, and SWA data were analyzed by comparing the total continuous and categorical activity scores, while concurrent validity of IPAQ and MAAS were analyzed by comparing follow-up scores. Test-retest reliability of MAAS was analyzed by comparing MAAS total physical activity scores at baseline and follow-up. Participants provided feedback in the follow-up questionnaire about their experience of wearing the armband to determine acceptability of the SWA. Data analyses included graphical (ie, Bland-Altman plot, scatterplot) and analytical (ie, canonical correlation, kappa statistic) methods to determine agreement between MAAS, IPAQ, and SWA data. Results: A total of 58 participants returned complete data. Comparisons between the MAAS and IPAQ questionnaires (n=52) showed moderate agreement for both categorical (kappa=.48, P<.001) and continuous data (r=.69, P<.001). Overall, the IPAQ tended to give higher scores. No significant correlation was observed between SWA and IPAQ or MAAS continuous data, for both minute-by-minute and blocked SWA data. The SWA tended to record lower scores than the questionnaires, suggesting participants tended to overreport their amount of physical activity. The test-retest analysis of MAAS showed moderate agreement for continuous outcomes (r=.44, P=.001). However, poor agreement was seen for categorical outcomes. The acceptability of the SWA to participants was high. Conclusions: Moderate agreement between the MAAS and IPAQ and moderate reliability of the MAAS indicates that the MAAS may be a suitable alternative to the IPAQ to assess total physical activity in young women, due to its shorter length and consequently lower participant burden. The SWA, and likely other monitoring devices, have the advantage over questionnaires of avoiding overreporting of self-reported physical activity, while being highly acceptable to participants. UR - http://publichealth.jmir.org/2015/2/e14/ UR - http://dx.doi.org/10.2196/publichealth.4259 UR - http://www.ncbi.nlm.nih.gov/pubmed/27227132 ID - info:doi/10.2196/publichealth.4259 ER - TY - JOUR AU - Dagan, Noa AU - Beskin, Daniel AU - Brezis, Mayer AU - Reis, Y. Ben PY - 2015/10/05 TI - Effects of Social Network Exposure on Nutritional Learning: Development of an Online Educational Platform JO - JMIR Serious Games SP - e7 VL - 3 IS - 2 KW - nutrition requirements KW - obesity KW - public health KW - social networking sites N2 - Background: Social networking sites (SNSs) such as Facebook have the potential to enhance online public health interventions, in part, as they provide social exposure and reinforcement. Objective: The objective of the study was to evaluate whether social exposure provided by SNSs enhances the effects of online public health interventions. Methods: As a sample intervention, we developed Food Hero, an online platform for nutritional education in which players feed a virtual character according to their own nutritional needs and complete a set of virtual sport challenges. The platform was developed in 2 versions: a "private version" in which a user can see only his or her own score, and a "social version" in which a user can see other players? scores, including preexisting Facebook friends. We assessed changes in participants? nutritional knowledge using 4 quiz scores and 3 menu-assembly scores. Monitoring feeding and exercising attempts assessed engagement with the platform. Results: The 2 versions of the platform were randomly assigned between a study group (30 members receiving the social version) and a control group (33 members, private version). The study group's performance on the quizzes gradually increased over time, relative to that of the control group, becoming significantly higher by the fourth quiz (P=.02). Furthermore, the study group's menu-assembly scores improved over time compared to the first score, whereas the control group's performance deteriorated. Study group members spent an average of 3:40 minutes assembling each menu compared to 2:50 minutes in the control group, and performed an average of 1.58 daily sport challenges, compared to 1.21 in the control group (P=.03). Conclusions: This work focused on isolating the SNSs' social effects in order to help guide future online interventions. Our results indicate that the social exposure provided by SNSs is associated with increased engagement and learning in an online nutritional educational platform. UR - http://games.jmir.org/2015/2/e7/ UR - http://dx.doi.org/10.2196/games.4002 UR - http://www.ncbi.nlm.nih.gov/pubmed/26441466 ID - info:doi/10.2196/games.4002 ER - TY - JOUR AU - Gelormini, Marcello AU - Damasceno, Albertino AU - Lopes, António Simão AU - Maló, Sérgio AU - Chongole, Célia AU - Muholove, Paulino AU - Casal, Susana AU - Pinho, Olívia AU - Moreira, Pedro AU - Padrão, Patrícia AU - Lunet, Nuno PY - 2015/08/05 TI - Street Food Environment in Maputo (STOOD Map): a Cross-Sectional Study in Mozambique JO - JMIR Res Protoc SP - e98 VL - 4 IS - 3 KW - fast foods KW - commerce KW - marketing KW - Mozambique N2 - Background: Street food represents a cultural, social, and economic phenomenon that is typical of urbanized areas, directly linked with a more sedentary lifestyle and providing a very accessible and inexpensive source of nutrition. Food advertising may contribute to shaping consumers? preferences and has the potential to drive the supply of specific foods. Objective: The purpose of this study is to characterize the street food offerings available to the urban population of Maputo, the capital city of Mozambique, and the billboard food advertising in the same setting. Methods: People selling ready-to-eat foods, beverages, or snacks from venues such as carts, trucks, stands, and a variety of improvised informal setups (eg, shopping carts, trunks of cars, sides of vans, blankets on the sidewalk, etc) will be identified in the district of KaMpfumu. We will gather information about the actual food being sold through direct observation and interviews to vendors, and from the billboard advertising in the same areas. A second phase of the research entails collecting food samples to be analyzed in a specialized laboratory. The street food environment will be characterized, overall and according to socioeconomic and physical characteristics of the neighborhood, using descriptive statistics and spatial analysis. The study protocol was approved by the National Committee for Bioethics for Health in Mozambique. Results: Data collection, including the identification of street food vending sites and billboard advertising, started on October 20, 2014, and lasted for 1 month. The collection of food samples took place in December 2014, and the bromatological analyses are expected to be concluded in August 2015. Conclusions: The district of KaMpfumu is the wealthiest and most urbanized in Maputo, and it is the area with the highest concentration and variety of street food vendors. The expected results may yield important information to assess the nutritional environment and the characteristics of the foods to which a great majority of the urban population living or working in Maputo are exposed. Furthermore, this study protocol provides a framework for a stepwise standardized characterization of the street food environment, comprising 3 steps with increasing complexity and demand for human and technical resources: Step 1 consists of the evaluation of food advertising in the streets; Step 2 includes the identification of street food vendors and the characterization of the products available; and Step 3 requires the collection of food samples for bromatological analyses. This structured approach to the assessment of the street food environment may enable within-country and international comparisons as well as monitoring of temporal trends. UR - http://www.researchprotocols.org/2015/3/e98/ UR - http://dx.doi.org/10.2196/resprot.4096 UR - http://www.ncbi.nlm.nih.gov/pubmed/26245231 ID - info:doi/10.2196/resprot.4096 ER -